When asked what substance he was first addicted to, guitarist Eric Clapton answered: “sugar.”  And we all know the person who kicked the “hard drugs” only to become reliant on food as their “go-to” addiction of choice.

So, are we all doomed for food addiction?

Well, 97% of people prescribed opioid painkillers (with no history of addiction) don’t become addicts.  And most of us wouldn’t rob a 7-11 for candy bars if the price of candy bars became unaffordable.  But some people are more susceptible to addiction, whether it’s opioids or candy bars.

Thus, addiction is complicated: Social, motivational, emotional, and genetic factors all interact to create an addiction experience. An addictive substance alone doesn’t create addiction. However, some things are more addictive than others.

We often joke “I’m a ___ addict”, whether that’s video games, shoes, or ice cream. But what, exactly, is real addiction? And is it a useful concept for understanding food behaviour?

What is addiction?

Addiction is an overpowering craving to repeatedly engage in an activity that provides temporary relief at the expense of terrible consequences. It’s something you feel compelled to do, even though it harms you.

To count as an addiction, there must also be withdrawal — feelings of discomfort, distress, and intense cravings – when our addictive substance or behaviour is taken away or stopped.

What is food addiction?

Thus, food addiction involves a regular compulsion to eat and/or consume particular foods, even though those foods harm us — whether that’s because the foods are unhealthy (e.g. high in sugar), or because they make us sick, or cause us to become obese.

An occasional big meal: not addiction. Regularly eating so much, and so rapidly, that you end up bloated and nauseated — but feel unable to stop? Potential addiction.

After having a couple of cookies (or any potentially addictive food), a non-addict will feel indifferent about eating more.  The experience of an addict is much different.  Addicts become utterly single-minded in the pursuit of their “hit”. Eating a couple of cookies (or any potentially addictive food) sets off an abnormal reaction – and they want more and more until they’re physically unable to swallow.

If you aren’t an addict, it’s not that you are a master of self-control, you just don’t have an insatiable appetite for more.

A food addict can be:

• an overweight woman who is always trying a new diet
• a man who eats beyond fullness at dinner after snacking on junk food all day to help deal with job stress
• a thin woman who never eats enough and is hungry all the time because she’s afraid of getting fat (in this case, her “hit” is not eating)
• a lonely guy with nothing to do on a Friday night except watch TV and eat several bags of chips
• a person who snacks all day to ease the boredom of an un-stimulating life
• a perfectionist who is never quite satisfied with their body
• a person suffering from a nutrition related disease (e.g., heart disease, diabetes, etc.) who gets disturbingly resistant when presented with treatment approaches

Some food addicts eat too much; some don’t consume enough.  For a food addict, food provides the fun, entertainment, control, reassurance, or love that’s missing in their life.  Food may also help to numb difficult emotions like fear and sadness.  Some people even have addiction to restriction.

The Yale Food Addiction test is a clinical tool for assessing food addiction (click to download in PDF).

Food dependence

But here’s the problem with determining food addiction: Unlike, say, heroin or gambling, we need food to live. Without an innate desire for food, we can wave bye-bye to evolution.

At what point does “big appetite” end and “food addiction” begin? And can you technically become “addicted” to something you need?

Researchers, while divided on the exact definition of “food addiction” or whether it truly exists, nevertheless agree that addiction is a pattern of behaviour characterized by things like:

• near-constant searches for a “hit”
• an intense compulsion and/or desire for the substance or behaviour
• strong, all-encompassing focus on getting that “hit”
• withdrawal symptoms when the “hit” is taken away
• needing more, or more intense “hits” as tolerance develops over time

By this definition, nearly anything — including food, water, or sex (i.e. things that are part of basic biology) — can be an addiction.

So let’s call it “food dependence”.

Over time, food (substance) dependence often becomes less about the high and more about preventing the negative feelings that come from abstinence.  The ability to get pleasure from the food becomes more difficult, because small amounts of the same food aren’t as rewarding.

Substance dependence: Official definitions

The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) defines “substance dependence” as 3 or more of the following 7 symptoms occurring within 1 year. We’ll look at how these might relate to food dependence.

Symptom 1: I use more over time.

Over time, tolerance increases.

Food example: When I used to buy groceries, I would take them home, eat a snack and go on with my day.  Now I buy groceries and I eat all day long until I have gone through half of what I bought.

Symptom 2: I have withdrawal symptoms.

I now take the substance to avoid withdrawal.

Food example: I eat processed snacks to correct being tired and/or depressed.  To fix anxiety, I eat something crunchy, like chips or crackers to calm myself. I am afraid if I stop using food to correct my emotions, I will have nothing else to turn to.

Symptom 3: I use more than I intend.

Food example: One bowl of ice cream turns into 2 bowls, then 3 bowls.  I start with one handful of chips and end up eating the whole bag.

Symptom 4: I’m trying or have tried to cut back.

I want to reduce my intake, and I’ve tried, but haven’t been successful.

Food example: I have tried to cut down or stop my eating, but it’s always on my mind and I find a way to defeat myself, even making a special trip to get a candy bar or chips.

Symptom 5: I spend time pursuing, using, or recovering from use.

I spend a lot of time on activities necessary to obtain the substance, or recover from its effects.

Food example: I will have a list of chores to do on Saturday.  I will go to the store and buy groceries and spend the rest of the day eating what I bought, taking antacids, and sleeping.

Symptom 6: I miss important activities because of my substance use.

I miss or give up important social, occupational, or recreational activities.

Food example: I come home and eat.  Then, I’m too full to exercise or meet with friends.

Symptom 7: I eat despite knowing the consequences.

I continue to abuse the substance despite knowing it’s giving me a persistent or recurrent physical or physiological problem.

Food example: I eat in spite of horrible knee pain from obesity.  I’m so uncomfortable after a binge that I can’t lay down without regurgitation into my esophagus.  My blood pressure is high.  I’m miserable.  I am embarrassed and afraid about being in social situations but I overeat anyway.

Time magazine graphic: Addiction: What happens in the brain?

What influences food addiction?

Many factors play a role in the development of food addiction.

Fear: Addicts may fear eating a reasonable amount of food, getting fat, and/or experiencing uncomfortable emotions and hunger.

Chronic overeating: Eating too much of highly processed foods can stimulate brain opiates — “feel good” chemicals. Regular bingeing might create a dependency on this “natural high”.  We become dependent on a highly processed diet to feel “normal” and experience withdrawal symptoms when we don’t eat it.

Food restriction: What if I told you that starting tomorrow you could never have ice cream again?  What would you do today?  Probably eat a bunch of ice cream – right?  Cravings and reward responses from food are greater after a period of food restriction (whether real or imagined) and/or nutrient depletion. This is why diets and extreme restriction almost inevitably lead to binges.

Stress: Various forms of stress can trigger addiction. Binging + food restriction + stress = a winning combination for food addiction. Addiction can lie dormant when things are going well, then rear its ugly head when life trouble strikes.

Depression: Depression usually changes appetite, hunger, and fullness signals, as well as sleep patterns (normally, good quality sleep helps us manage urges — sleep is “willpower fuel”).

Weak satiety mechanisms: Some people who struggle with food addiction aren’t as tuned in to their fullness cues. They “hear” hunger signals more loudly than satiety signals.

Automaticity: Food behaviours can be strongly ingrained habits that “wear a groove” into our nervous system. Some argue that they can’t be eliminated — just rendered dormant (temporarily).

What makes food addictive?

Are all pleasurable foods automatically addictive?  Probably not.

Hyperpalatability

Processed foods are engineered in ways that exceed basic reward properties of traditional whole foods, making them hyperpalatable.

Consider items such as ice cream, burgers, candy, melted cheeses, buttery/oily sauces, and so on – these are the foods that stimulate the release of opioids and dopamine in the brain and have addictive potential (note: artificial sweeteners can even trigger a dopamine response).

Rodent studies confirm this: Rats are unlikely to binge on normal rat chow. But when given the option of sweeter and fattier rat chow, rats go on a bender.

The table below shows the characteristics of some “normal” foods and some hyperpalatable foods. Notice how much higher in sugar, fat, and/or sodium the hyperpalatable foods are — and how many ingredients each food contains.

What differentiates regular from hyperpalatable foods? Source: Gearhardt AN, et al. Can food be addictive? Public health and policy implications. Addiction. 2011;106:1208-1212.

Other things can contribute to the addictive potential of food:

Quantity: When served more, we eat more.

Processing & energy density: The right mix of fat, sweeteners, flours, caffeine and salt provides a strong reward.  Plain sugar packets or a bottle of olive oil aren’t very desirable.  Processed foods have combinations of ingredients not found in nature.  Many food components, like drugs, are not addictive until extracted and concentrated by modern processing (a whole grain vs. white flour in cake, a whole fruit vs. sugar in cookies, cocaine vs. cocoa leaves, opium vs. poppies, etc.).

Variety: When there are different colours, sizes, shapes, tastes, and textures, we eat more.  People will eat more cookie dough ice cream versus plain vanilla and more trail mix versus plain raw almonds.

Nutrient composition of foods: When we eat nutrient-poor foods, we may end up eating more overall food in order to meet nutrient needs.

Access: The number one factor in addiction is availability.  If the substance isn’t available, we can’t develop an addiction.  When the substance is readily available, addiction will be more common (think: cigarettes in vending machines).

Cultural norms: When a behavior/substance is accepted within a group, it’s unlikely that behaviour will stop. Many folks cut down on or quit smoking when jurisdictions outlawed smoking in restaurants and bars.

Individual preferences

Think about what foods have an “addictive” potential for you.  It’s important to consider these questions because any one food isn’t universally “addictive.”

• What foods do you crave?
• What foods do you think about you aren’t physically hungry?
• What foods do you want to eat more of, even when you’re full?
• What foods do you typically deprive yourself of — but later, feel unable to control yourself around?
• What foods have emotional associations for you — say, foods you remember from childhood, or foods that seem to have “special powers” to make you feel better?

Answers to the aforementioned questions don’t usually include barley, pears, asparagus and black beans (but it’s possible).

While whole foods in their most unprocessed form are still potentially addictive (think sweet fruits and fatty nuts), the potential for true dependence/addiction is low compared to processed foods (such as fruit candies and flavoured fatty nuts).

Treating addiction

People aren’t responsible for having an addiction, but they are responsible for dealing with it.

To treat addiction, you must address the following factors:

Food availability and environment

If you feel out of control with certain foods or in certain situations, you probably are.

Our behaviour depends heavily on social and environmental cues. We can adjust our behaviour by adjusting cues from our routine and environment.

Thus: Avoid people, places, and things that trigger addiction. Use social pressure to your advantage. Addicts don’t like to use their drug with sober people staring at them.

The more available — and socially acceptable — an addictive substance is, the easier it is to get hooked. Make it hard to get.

Emotions

Food doesn’t help resolve emotions. And emotions aren’t a bad thing. They actually serve a useful purpose in life and can indicate that something is out of balance.

Food can be used as a coping mechanism for emotions that feel intolerable. Once a “food rush” wears off, we’re left with the very same emotional problems… plus the additional problems addiction brings.

Many addictions stem from uncontrolled stress combined with food restriction. If these two factors can be controlled, food addiction might also be controlled.

Pharmaceuticals

What about appetite suppressants and drugs that eliminate the high from addictive foods?  These so-called solutions open up new problems (e.g., undereating, malnutrition, etc).

Compliance to pharmaceuticals like naltrexone (blocks the high someone gets from a drug) and antabuse (makes someone sick if they drink alcohol) tend to be poor.  Why?  Because people want the high again.  Even if an appetite suppressant drug is developed, the food addiction will still remain.  This has little to do with the addictive food itself and more to do with a deficiency elsewhere in life – boredom, loneliness, anger, lack of stimulation, lack of purpose, etc.

Cravings die as a side effect of changing our life and identity — medication is, at best, only a partial and temporary solution.

However, pharmaceuticals that may be useful in addiction recovery include those that treat underlying conditions leading to emotional distress (pain, depression, etc.).

Abstinence

While we can’t choose to be addicted, we can choose to abstain in order to sustain recovery. Some claim that as an addict, it’s easier to give up the addictive substance entirely than to negotiate with it.

In this case, freedom comes when we give up effort to control the substance and become abstinent. Recovery from addiction means having the restoration of choice.

However, abstinence means that addicts must be willing to face discomfort. Luckily, the longer an addict remains abstinent, the more biological urges for the substance fade. Withdrawal is worst in the beginning.

If urges return, they’re often the result of conditioned reflexes and/or the desire to escape emotional distress. Managing stress and knowing “triggers” is thus an important part of recovery.

Meaning

Recovery from addiction needs meaning and purpose.  Without meaning, there is no reason to remain abstinent.

External meanings (e.g., how the body looks, a spouse, a friend) can be fleeting.  We love them one day, hate them the next.

If we count on external meanings for sustained change, there’s a good chance we’ll be dissatisfied. Dissatisfaction fuels resentment, and soon enough we remember that overeating is a quick way to forget about the entire mess.

Meaning is one of the reasons why the idea of a “higher power” in many addiction recovery programs is appealing.  A higher power isn’t fleeting, it’s eternal. However, what’s most important is that the meaning and purpose is internal — it comes from the inside and reflects the person’s deeper values and life priorities.

Getting a handle on food addiction often requires a temporary hiatus from mirror and scale obsession. Instead, we must prioritize what’s going on inside.

Dieting

Reason is no match for addiction. Addiction is mostly an emotional-biological phenomenon.

Thus, addicts tend to be unable to rely on self-control alone — which doesn’t mean they are “weak”. (In fact, given how hard most food addicts try to change — even if unsuccessfully — arguably their will is very strong.)

The struggle with food addiction often leads to dieting, over-exercising, purging, drugs, binging, and weight gain/loss.  These are efforts to control the addiction, but these efforts are often unrealistic, become lenient, and eventually fail (and this failure can lead to more addictive behaviors). In fact, restriction and obsession with “fixing the problem” itself can create more rebounds.

Structural changes

“Willpower” helps, but it’s weak compared to structural and foundational changes. This includes things like:

• changing one’s physical environment
• building a social support system (including getting away from people who enable the addiction)
• making it tougher to get at the addictive substances
• decreasing life stress, and/or working on stress management
• learning to tolerate discomfort, and getting support in doing so
• changing one’s routine and schedule to favour positive behaviours, and diminish the chances for negative behaviours (which can include things like getting more sleep, seeking out safer situations during “trigger times”, scheduling activities that conflict with the addictive behaviour, etc.)

Other tidbits and factoids

Food addiction factoids

Reward threshold — or the amount of substance needed to get a “high” — increases over time. Addicts need more and more. Eventually, many don’t get a “high” or any pleasure at all — the addiction focuses around managing withdrawal.

Reward thresholds increase over time. Source: Kenny PJ. Reward mechanisms in obesity: New insights and future directions. Neuron. 2011;69:664-679.

The earlier we start eating hyperpalatable foods, the more likely we are to get hooked on them. This means that good childhood nutrition is very important — and processed foods targeted at children are a major potential health problem.

In related factoids, the longer we’re exposed to innately desirable foods, the more difficult they are to resist.  Self-control is a limited resource. So, if you struggle with being near certain foods, get away from them — fast. Get them out of your house, and move yourself away from them. Don’t torture or tempt yourself with physical proximity.

Those who prefer to binge on sweet foods tend to binge more frequently than folks who prefer to binge on fatty or salty foods.

Addicts often have higher levels of dopamine circulating in their brains than non-addicts. It’s not clear whether that’s a cause or consequence of eating.

Binge eating (independent of body weight), rather than weight, is more closely associated with addictive eating patterns. In other words, behaviour predicts addiction better than body size, weight, or fatness.

Some data indicate that compared to women, men are more likely to overeat once they begin, and are more likely to eat more than their body needs.

Philosophical musings

In the U.S., many self-destructive compulsions are considered normal. This means it’s harder to identify problem behaviours as addictions or dependencies. Indeed, if someone were to design a society ideal for food addiction – North America would probably be it.

If we quit eating a certain food – are we addicted to abstaining?

Buddhist teachings have long stated that attachment is the root of all suffering. Could this — along with mindfulness training and learning to “be present” with discomfort — be the key to unlocking addiction?

Further resources

What’s harder to kick – food or chemicals? 

Substance related disorders

Food Addiction Summit

Food Addicts Anonymous

For more on appetite and addiction, see here:

All About Appetite – Part 1

All About Appetite – Part 2

Research Roundup: Food Addiction

Is Food Addiction Real?

Kessler, David. The End of Overeating.  2009.  Rodale.

Barnard N & Stepaniak J.  Breaking the Food Seduction.  2003.  St. Martins.

References

Velez-Mitchell.  Addict Nation.  2011.  Health Communications, Inc.

Finlayson G, et al.  The Regulation of Food Intake in Humans.  http://www.endotext.org/obesity/obesity7.3/obesity7-3.html

Cohen DA.  Neurophysiological pathways to obesity: Below awareness and beyond individual control.  Diabetes 2008;57:1768-1773.

Milkman KL, Rogers T, Bazerman MH.  Harnessing our inner angels and demons: What we have learned about want/should conflicts and how that knowledge can help us reduce short-sighted decision making.  Perspectives on Psychological Science 2008;3:324-338.

Five Techniques for Avoiding Short-Sighted Decision-Making. PsyBlog. http://www.spring.org.uk/2011/06/five-techniques-for-avoiding-short-sighted-decision-making.php
Committee on Assessing Interactions Among Social, Behavioral, and Genetic Factors in Health, Lyla M. Hernandez and Dan G. Blazer, Editors.  Genes, Behavior, and the Social Environment: Moving beyond the nature/nurture debate.  2006.  National Academy of Sciences.  http://www.nap.edu/catalog.php?record_id=11693

Kessler DA.  The End of Overeating.  2009.  Rodale.

Barnard N.  Breaking the Food Seduction.  2003.  St. Martins.

Szalavitz M.  Heroin vs. Haagen-Dazs: What food addiction looks like in the brain.  April 4, 2011.  http://healthland.time.com/2011/04/04/heroin-vs-haagen-dazs-what-food-addiction-looks-like-in-the-brain

Szalavitz M.  Hooked on addiction: From food to drugs to internet porn.  April 15, 2011.  http://healthland.time.com/2011/04/15/hooked-on-addiction-from-food-to-drugs-to-internet-porn/

Parylak SL, Koob GF, Zorrilla EP.  The dark side of food addiction.  Physiology & Behavior 2011;104:149-156.

Wenk GL.  Your brain on food.  2010.  Oxford University Press.

Obesity and food addiction summit webcasts: http://www.foodaddictionsummit.org/agenda.htm

Avena NM, Rada P, Hoebel BG.  Evidence for sugar addiction: Behavioral and neurochemical effects of intermittent, excessive sugar intake.  Neurosci Biobehav Rev 2008;32:20-39.

Gearhardt AN, et al.  Can food be addictive?  Public health and policy implications.  Addiction. 2011;106:1208-1212.

Sandor RS.  Thinking simply about addiction.  2009.  Penguin Books.

Blumenthal DM & Gold MS.  Neurobiology of food addiction.  Current Opinion in Clinical Nutrition and Metabolic Care. 2010;13:359-365.

Ifland JR, et al.  Refined food addiction: A classic substance use disorder.  Medical Hypotheses. 2009;72:518-526.

Kenny PJ.  Reward mechanisms in obesity: New insights and future directions.  Neuron. 2011;69:664-679.

Avena NM, Rada P Hoebel BG. Sugar and fat bingeing have notable differences in addictive-like behavior. J Nutr. 2009;139:623-628.

McQuillan S. Breaking the bonds of food addiction.  Psychology Today.  2004.  Penguin Group.

Kiernan J.  Why Food is Addiction is Often Deadlier Than Drinking or Drugs. The Fix.  June 23, 2011.  Accessed here: http://www.thefix.com/content/oa-vs-aa

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How can something as trivial as a paper cut be so huge, when something as damaging as a break could happen without our awareness?

What these simple differences tell us is that pain is a rich, complex experience. Pain involves not just the physical experience of some injury (or threat of some injury), but, according to research over the past 30+ years, pain involves processing stimuli from various inputs, including social, psychological and physiological experiences.

Pain is interpretation

Research in pain indicates that the electro-chemical signals from an injury do not of themselves always say “pain” to the brain. The same signals triggered in the body that say “pain” today may just be translated as “frustration” tomorrow.

In other words, pain is cognitive: it’s an interpreted event in which the brain takes in multiple signals – including physical, social, psychological input – and then decides whether the combined output says “pain.”

At its most fundamental level, we can say that:

1. Pain is not the same thing as injury.

2. Pain takes place not at the site of injury but in the brain.

Research also tells us that the brain interprets a particular input as pain when it perceives something jeopardizing the body’s balance (homeostasis).

Likewise, the role of pain seems to be an action signal: a signal that, if perceived, means something needs to be changed to restore the body’s homeostasis. This gives us a third point:

3. Pain is a signal to change.

One of the challenges for physical culture and rehab is that the site of pain is not always the source of pain. While pain is a brain signal, it does not necessarily tell us what is wrong. All we know is that our brain thinks something threatens our homeostasis.

Acute & chronic pain

Generally speaking, pain breaks down into two categories (though the International Association on Pain Studies has about 30 categories of pain).

Acute pain

According to the International Association for the Study of Pain (IASP), acute pain would be a sudden back twinge during deadlifts, or banging your shin into the barbell.

Acute pain is generally associated with an injury (or anticipated injury) and is site specific. With acute pain, the sufferer can usually show exactly where the pain is, and what triggers it. The pain is sharp and clearly defined. If there has been tissue damage, there can be swelling or later scarring.

Chronic pain

Chronic pain is more like the nonspecific shoulder or backache that’s been around for a year. Chronic pain is ongoing and tends to be more diffuse.

Chronic pain can be particularly challenging, because its intensity can come and go. It can often be unpredictable, and not always associated with specific events. For instance, sufferers might just wake up sore some days.

Sufferers of chronic pain often reduce their movement (to reduce pain), and fear the types of movements that seem to stimulate the pain, although it may not be a specific movement that induces the pain. Although chronic pain may be accompanied by inflammation, there may be no physical signs that there is any particular tissue repair work going on.

In both acute and chronic pain cases, however, pain-free movement can be a way to accelerate healing and break chronic pain cycles.

Managing pain with movement

Thus:

• Pain is an action signal.
• Pain a signal to change, but not a prescription for rehab.
• Pain is indicative rather than diagnostic.
• Pain is the brain telling us that something is threatening our homeostasis; it doesn’t tell us specifically what is wrong or what to do about it.

Pain is often described as acute or chronic. And for those of us who work out or play physically, acute or chronic pain seems to be par for the course.

Unfortunately, the two most common sports responses to pain – work through it or stop moving until it goes away – are both largely wrong. Turns out, we need to keep moving, but, unless it’s life and death, never move into pain.

Movement we know is a key part of health. Because of how we’re wired, movement — though again, not into pain — actually plays an important role in pain management.

Silencing pain signals

In the gym or on the field, if we experience a twinge, we often ignore it until it becomes a scream. The best response to an immediate pain, however, as soon as it happens is:

1. Stop what we’re doing – whether it’s a muscle cramp or just a twinge.
2. Reduce speed – recheck.
3. If there’s still pain, reduce load – recheck.
4. If there’s still pain, reduce range of motion.
5. If there’s still pain, do some other movement that incurs no pain.

In each of these tests, the advice is not to stop moving our body but where possible to keep moving the affected body part without pain.  Find a pain-free way to move.

The importance of movement

Movement is a key signal to our bodies about how well we’re doing. We are designed as “use it or lose it” systems, constantly adapting to what we do (see discussions of Woolf’s Law for bone formation and Davis’ Law for tissue; also see Lederman reference below for reducing scar tissue formation).

Our bodies adapt to the demands — or lack of them — they experience. If we don’t move something for a while, our bodies begin to adapt to support that lack of movement. Unused bone disappears. Unused muscles atrophy.

Our bodies compensate in other ways too, to make up for the lack of mobility. We often get new pain as a result of those compensations. For instance, our joints may swell, or muscles may complain when asked to do work for which they were not designed.

For instance, let’s say you have pain in your right hip. You start favouring your left leg to compensate. While this makes your right hip feel better (sort of), you eventually get pain in your left leg and hip, because you’re suddenly doing much more unbalanced work on the left hand side. Then, maybe your right shoulder starts to hurt, or your neck, because you’re walking around lopsided like a boat with one oar, and it’s pulling on your spine.

Here’s another common example. Your back hurts. So you go to bed. After a few days of lying around, you feel worse. Now your shoulders and neck hurt too. Your hips hurt from the pressure of lying down. Not a great solution!

Thus, immobilizing oneself can create a vicious cycle. Compensating for one painful movement induces other restricted movements.

By staying as mobile as possible, at every joint, without pain, we signal two things.

First, movement says we are still using this part of our body and thus this body part needs resources for healing and growth.

Second, the movement signals themselves can overwhelm a pain signal to say there’s more right than wrong going on in the area: there are more nerves that tell the body how we’re moving than nerves that say there’s something wrong.

Movement nerves (mechanoreceptors) are also easier to turn on than nerves that trip in the presence of noxious stimuli. This receptor ratio is used to great effect when we drop a weight on our thumb and then shake and rub the area and find the pain is reduced, as per the Oh Canada section in All About Dynamic Joint Mobility.

Managing pain: a complex system response

Beyond reducing the intensity of an immediate pain experience by reducing load, speed and range of motion, we can help protect ourselves from pain by considering our somatosensory system in our skills practice.

Prevention: movement, balance and vision practice

The somatosensory system includes a hierarchy of three interdependent systems:

1. the visual system (what we see);
2. the vestibular (our sense of balance and orientation relative to gravity); and
3. the proprioceptive system (our sense of movement and position in space).

If our nervous system perceives a threat to any of these systems, it can trigger compensations and eventual pain responses.

For instance, if someone has an esophoria – a condition where an eye may tend to pull in (example here) — that condition makes objects appear closer than they are. Imagine always reaching for something thinking it’s closer than it is, and having to readjust constantly.

This micro miscue and constant readjustment results in a low-grade ongoing stress that may affect muscular posture and eventually contribute to what becomes a chronic strain. Just rehabbing muscles of the body won’t eliminate the problem – we need to address the eye muscles too.

We can address this in the same way that we train: using movement work.  Here, sports vision training can help address the phoria and enhance visual performance, often improving proprioceptive and vestibular performance too, also often ultimately addressing the pain signal’s request for change.

Remember, the site of pain is not always the source of pain. In this case, the source of pain is the eyes’ muscular coordination. The site of pain may, in fact, be posture — or any number of other underlying problems.

It’s important to note that there are a variety of ways to address pain via better movement, balance and vision skills. This is not to say that glasses or orthotics or drugs are wrong; just that work with the somatosensory system is a powerful, if often overlooked, way to work with the body to improve performance and reduce pain.

A movement program can be used as a cornerstone of such a mixed practice to reduce the incidence of injury in physical practice and to help manage or even eliminate chronic pain. See All About Dynamic Joint Mobility for program suggestions.

Response: movement assessment

If we’ve experienced fresh or ongoing pain, it may help to seek out a movement assessment. This means being assessed in motion.

This guidance may seem obvious, but it’s not in practice. Many of us have seen specialists that will look at how a painful limb moves, or test our range of motion while lying on a table or standing still, but may not consider how we carry ourselves as we walk down a hallway.

Likewise, some approaches may deal only with musculo-skeletal issues. If that works, great, but if it does not, that may be a sign that some other part of the somatosensory system – like the phoria example above – is at play, affecting performance.

Pain is a signal to change. Until the underlying issue is identified and addressed, the signal to change may keep coming.

Moving forward, pain free

• Pain takes place in the brain. It is an outcome of the cognitive interpretation of multiple signals, from social to physical to neural.
• Pain is a response to actual or perceived threat to the body’s homeostasis. The same action may be interpreted differently under different circumstances, depending on whether the body thinks it’s a threat.
• The site of pain does not equal the source of pain.
• Pain is individual. Our experience of pain can change, depending on who we are, what we’re doing, and the context in which we experience it.
• Pain is a signal to change; it is not a prescription of what to do or where to go.
• Pain often directly affects quality of movement. However, one of the worst things we can do in response to pain is either ignore it and keep going (the tough it out, “no pain no gain” response) or respond to it by shutting down movement (the chronic pain vicious circle).
• Movement that does not cause pain is often an effective path to better function. It both reduces the duration of acute pain and helps to address the intensity or frequency of chronic pain.
• A movement assessment – especially one that considers somatosensory responses from the integrated visual, vestibular, and proprioceptive systems — can provide insight about movement strategies to help address a particular pain and improve performance.

References & related resources

Butler, D, Moseley, L, Sunyata. Explain Pain. Aus. Orthopedic Physical Therapy Products, 2003.

Cobb, E, Mauck, K, Mauck, S. The Essentials of Elite Performance (DVD Mini-Course) Z-Heath Performance Solutions, Arizona USA, 2010.

DeLeo, Joyce A (2006). Basic science of pain. The Journal of bone and joint surgery. American volume 88 Suppl 2 p. 58-62. PMID 16595445.

Iannetti, G D, and A Mouraux, “From the neuromatrix to the pain matrix (and back).” Experimental brain research. Experimentelle Hirnforschung. Experimentation cerebrale 205, no. 1 (July 2010): 1-12-12 http://www.springerlink.com/content/x6p070657v2tt6k6/ (accessed July 11, 2010).

Lederman, E. The Science & Practice of Manual Therapy. London: Elsevier, 2005

Melzack R, Wall PD. Pain mechanisms: a new theory. Science. 1965;150(699):971–9. PMID 5320816.

Melzack, Ronald, “Evolution of the neuromatrix theory of pain. The Prithvi Raj Lecture: presented at the third World Congress of World Institute of Pain, Barcelona 2004.” Pain practice : the official journal of World Institute of Pain 5, no. 2 (June 2005): 85-94 PMID 17177754.

Sonnon, Scott. Body Flow. Atlanta, USA: RMax.tv Productions, 2003.

Squire, L. and Colleagues. “Somatosensory Systems (Chp 25).” Fundamental Neuroscience, 3rd Edition. New York: Elsevier Academic Press, 2008.

Wilson, T.A., Falkel, J. Sports Vision: Training for Better Performance. Champagne, Il., USA: Human Kinetics, 2004.

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What’s the #2 reason? Lower back pain.

80% of adults report lower back pain at some point in their lives and 10-15% of all sports-related injuries involve the spine. Low back pain accounts for more lost person hours than any other type of occupational injury and is the most frequent cause of activity limitation in those under age 45.

Thus, it’s important to understand what the spine is, what it does, and — most importantly — how we can keep it healthy.

What is the spine?

Along with opposable thumbs that we can use to work the TV remotes we invented, one of the things that distinguishes us from many other animals is our spine. The spine provides structural support for our bodies, protection for our central nerves, and facilitates locomotion (aka movement).

The spine is made up of 24 semi-rigid presacral vertebrae (seven cervical, twelve thoracic, five lumbar) separated by discs. Five sacral vertebrae fuse to make up the sacrum, which helps transfer upper body weight to the pelvis through the sacroiliac joint. The coccyx (tailbone) makes up the bottom of the vertebral column.

The natural curves of the spine

Intervertebral discs hold vertebrae together, act as shock absorbers, and allow dynamic spinal movement. These discs measure around one centimetre in height and consist of a gooey center (nucleus pulposus) surrounded by connective tissue (annulus fibrosis). (Think of an Oreo with the disc as the filling and the vertebrae as the hard cookies.)

Bony projections come together along your mid-back to form the spinous process, which you can feel and see.

The cervical spinous process

Ligaments run along the spine and provide stability, helping the spine protect nerves extending from brain to body.

Spinal muscles and their roles

Several muscle groups attach to the spine or play a critical role in spinal health. Problems with these muscles can cause back pain. (For more on how this works, see the next section.)

1. Iliopsoas (psoas + iliacus) complex

These lie deep within the abdomen and hip, connecting the lumbar vertebrae and the iliac crest to the top of the femur. They’re major movers during bent knee leg raises and sit ups.

Aggravated with: Lots of sitting/driving, lots of kicking (martial arts or soccer), long bike rides in bent position, and sleeping in the fetal position.

2. Paraspinals

These are like the spine’s “suspenders” and help to control rotation, extension and bending. This group includes the erector spinae and multifidus along the spine.

Aggravated with: Sudden spinal overload, repetitive movement with poor technique, hunched posture, tight abdominal muscles, and lots of sitting.

3. Rectus abdominis

This sheet of muscle is your “washboard abs”. It runs between the lowest ribs and top of the pubic bone, and helps stabilize the torso. Excessive training of the rectus abdominis (at the expense of posterior chain muscles) can diminish the ability to carry weight overhead (think jerks, snatches, overhead presses) and lead to lower back injury. So: fewer crunches, more swings.

Aggravated with: Too many crunches (especially without posterior chain training), over-exercising, excess abdominal fat, reliance on weight training belts.

4. Gluteus group: maximus/medius/minimus

Aka the booty, these are the muscles that help bring your thigh behind you (think: donkey kicks), rotate it, and bring it to the side.

Aggravated with: Prolonged sitting, sleeping in fetal position with knees pulled up, sitting on your wallet, standing for long periods on one leg, sleeping on your back with feet splayed under the weight of a heavy blanket.

5. Piriformis

This small muscle lies deep within the glutes and connects the thigh to the pelvis near the sacrum. It rotates the thigh outward and swings the leg to the side when the thigh is flexed.

Aggravated with: Distance running (repetitive overuse in general), prolonged contraction (such as driving a car), sitting with one foot underneath you, walking with duck feet (toes out), sitting too much.

6. Quadratus lumborum

The “QL” lies deep in the side of the torso around the kidneys. It helps to bend, rotate, and straighten the torso from bent position. It also helps with exhalation (coughing, etc.), which many folks discover when they strain the QL and then live in fear of sneezing.

Aggravated with: Structural imbalances (one leg longer, uneven pelvis, etc.), habitual leaning to one side, slouching, always sleeping on one side.

7. Hamstrings

These big leg muscles run along the back of the thighs, attaching at the hip and the knee. They bend and stabilize the knee.

Aggravated with: Pressure from chairs, prolonged sitting, bed rest, overload (e.g. lots of sprints when a trainee isn’t used to sprinting).

8. Soleus

This deep calf muscle assists with walking, jumping, and pointing the toes. When irritated, pain can radiate to the sacrum.

Aggravated with: High heeled shoes, rigid/tight shoes, bedding that weighs down toes, standing still for extended periods, prolonged driving, sitting on chair that is too high (so the feet don’t touch the floor).

What can lead to spinal problems?

Usually, spinal problems are multifactorial. Predisposing factors include:

• Poor mobility in surrounding muscles
• Bad biomchanics
• Poor posture
• Weakness of supporting musculature
• Muscle imbalances
• Sedentary lifestyle, sitting, and immobility

Poor mobility in surrounding muscles

The pelvis is the foundation for the spine. Decreased mobility in the hips, hamstrings, ankles, and thoracic spine can lead to overcompensation at the lumbar spine and excessive pelvic tilt. This problem is particularly common in women — in part because of higher heels, but also because the connective tissues of an average woman’s spine are usually looser than the average man’s.

Bad biomechanics

Back pain only gets worse with poor biomechanics.

Most spine injuries that occur during training are muscle strains or ligament sprains, usually due to improper loading and technique. A common error is lumbar flexion during movements like good mornings, situps, deadlifts, and rows. Excessive lumbar extension is also dangerous and can lead to vertebral fracture (e.g., finishing a heavy deadlift).

The safest position for the lumbar spine is a neutral position — a natural but not exaggerated S-curve (double check the spine image at the top of this article for reference). You can find a neutral spine by flexing your lumbar spine, then extending it and trying to find the midpoint between the two, or by standing tall and taking a deep breath. Use a mirror to check.

Nice neutral spine

My disc just herniated looking at this picture (too much spinal flexion)

It’s important to get good at the movements you regularly do. If you’re always lunging and twisting for martial arts or your plumbing job, get good at lunging and twisting. Don’t just go home at night and do situps hoping to preserve your back.

Poor posture

If your posture sucks, your back sucks.

Poor posture means higher levels of shear stress on the spine. When posture is appropriate (proud chest, natural lumbar curve, tight core, retracted shoulder blades, etc.) – then we’re able to handle higher amounts of compressive force. Oh, a big gut and high heeled shoes can negatively influence posture. Try to avoid one or both as much as possible.

Weakness

Many people assume that strong abs help them bend and twist. This is true, in part, but most often the core’s role is stability rather than movement — in other words, preventing motion rather than initiating it. Too much flexion or extension at the lumbar spine, usually caused by weak core muscles, can lead to injury. It’s also biomechanically weaker. You can throw a lot farther or punch a lot harder when your hips and shoulders are involved than when you’re just twisting at the waist.

Reliance on weight lifting belts can lead to torso stiffness and weakness.

Imbalances

Folks with chronic back pain often neglect the posterior chain (i.e. the muscles that run along the rear of the body from neck to ankles). This is especially true for gym rats who do too much bench pressing and not enough pulling or hip extension. This keeps back problems in full force (plus said gym rats end up looking like light bulbs).

Single leg exercises help develop the lower body and immediately challenge the lower back and hips, building stability and function. We tend to be weak and imbalanced on extension movements because we do them less.

Not moving

Doctors used to recommend bed rest for back pain. Now they usually recommend movement. And, as you can see from the list of muscle problems above, “too much sitting” factors into a host of back problems.

When we sit or lie around all day, intervertebral discs absorb fluid and become tighter, allowing less range of motion and promoting injury. Introduce yourself to regular movement (warm ups, yoga, and dynamic joint mobility, along with walking and swimming). These all help to preserve spinal health. See here:

All About Warming Up

All About Yoga

All About Dynamic Joint Mobility

Other common problems

“Spondylo”s

A collection of spinal dysfunctions known as the “spondys” can result from spinal fracture, overtraining, and/or over-extension/twisting of the spine. They’re common, for instance, in gymnasts and yogis who repeatedly bend backwards. They can also occur acutely in high-impact sports such as rugby.

• Spondylitis is an inflammation of the vertebrae.
• Spondylosis is osteoarthritic narrowing of the vertebral space.
• Spondylolysis is a fracture, usually a stress fracture, of the pars interarticularis. It can lead to a spondylolisthesis.
• Spondylolisthesis, which can occur after a spondylolysis, is the forward slippage of one vertebrae on another. Think of a stack of books in which one book is pushed forward.

Excessive flexion, extension and rotation are bad news for anyone with spondylo-situations. Work on building mobility of the hip flexors, hamstrings and ITB.

Prolapsed disc

This occurs when intervertebral disc material bulges from its normal confines. Minor tears to the outside of discs can lead to inner disc leakage.

The key is to never let the problem start. Translation: build core stability.

Treating and preventing spinal dysfunction

Get moving

As mentioned above, movement is good, and inactivity can cause/exacerbate back pain.

• Resistance training helps build strength and endurance in the supporting musculature, and help activate weaker or inhibited areas.
• Mobility training helps improve active flexibility in tight areas.
• The intervertebral discs lack blood vessels. The only way they can absorb nutrients is through spinal movement. If you want to deprive your discs of nourishment, lie down and sit around a lot.

But before you randomly start lifting, running, twisting and jumping, think WWDMD (What Would Dr. McGill Do)? Spine biomechanicist Dr. Stuart McGill encourages the following approach when it comes to exercise design:

1. Do necessary corrective exercises
2. Groove appropriate movement patterns
3. Build full body joint mobility/stability
4. Increase core endurance (rather than maximal strength)
5. Build full body strength
6. Develop speed, power, and agility

How many people do you know that start at #1?

Spines & squatting

Squatting with poor mechanics will result in injury.

Squatting with added weight puts compressive forces on the spine. Why don’t we see more spinal blowouts at the gym? Luckily, our spine can adapt to compressive tolerance. But our spines need time to adapt. Take your time and allow this adaptation. To assist the process, build up your paraspinal muscles with exercises involving spinal extension and stabilization.

Double check squat form:

• Take a wider stance (at least shoulder width – if not wider)
• Use natural foot positioning (similar to other athletic movements)
• Keep heels in contact with the floor
• Gaze forward or slightly up
• Maintain lordotic curve in lower back — don’t round
• If back squats don’t work, try front, zercher and goblet squats
• Focus on hip extension — drive from the glutes and hips.

Intra-abdominal pressure (IAP) can help to stabilize the spine during squats. Momentarily stopping the breath and stiffening the abs to make the spine go rigid (think of what you do when you sneeze, or when you know someone is about to punch you in the gut — if you make a little “ungh” sound, you’re probably doing it right) will generate IAP.

Stabilizing the cervical spine

Neck muscles work isometrically to stabilize the cervical spine. A stable cervical spine is critical for contact sports. Thus, folks with greater musculature in the neck and shoulders have a better chance of withstanding cervical impact.

Forcing the cervical spine into excessive flexion or extension with resistance can lead to breakdown of joints and discs.

To build the cervical spine, try incorporating the following exercises. Hold for 10 seconds each, and do 1-5 sets:

1. Isometric neck flexion (forwards)
2. Isometric neck extension (backwards)
3. Isometric lateral neck flexion (right and left)
4. Isometric neck rotation (right and left)

Mobility warmup

Here are some sample mobility drills that can keep the spine mobile yet stable in all the right places.

Cat/cow spinal warm up

Foam roll the thoracic region (from 1:30 to 2:10 in video)

Thoracic mobilization

T push up

Stretch hip flexors

Reverse bridge with back on Swiss ball (for intermediate and advanced folks, begin alternating legs “marching”)

Squat to stand with reach

Finishing with spinal health movements

To promote spinal health, add some of the following to the end of your workout

McGill curl-up

Stir the pot

Side bridge

Bird dog (move the leg and arm laterally to make it harder)

Pallof presses

TRX back saver (from 0:58 to 1:40 in video)

To promote spinal health, try the following between workouts.

Instead of bending at the lumbar spine to pick something up from the ground, try the golfers pick up (unilateral deadlift):

Instead of squatting to get down on the floor, try going into a lunge and keeping your spine neutral.

Mix in some yoga

Yoga may help improve posture through development of extensor muscles and thoracic mobility. Vinyasa yoga is likely the best option for back health due to its dynamic nature. Try to focus on a neutral spine when statically stretching.

Balance

Standing on an unstable surface (like a balance board) recruits stabilization musculature.

While on this surface, assume a position of slight knee and hip bend while contracting the lower torso muscles. Then flex your arms in an alternating fashion while maintaining position. Try this for 1 minute, 2-5 times through. If this doesn’t help your spine, at least you’ll now be known as the balancing flailing loser in your neighbourhood.

Source: Kolber MJ & Beekhuizen K. Lumbar stabilization: An evidence-based approach for the athlete with low back pain. Strength Cond J 2007;29:26-37.

Summary and recommendations

Spinal health comes from a complex interplay of mobility in some areas and stability-strength-endurance in others. Many muscle groups are related to spinal health — ensure that you aren’t prioritizing the “beach muscles” (aka chest and abs) over the more important structural supporters like spinal extensors and glutes/hips/hamstrings.

Sitting is bad news for your spine. Get up and move. If you’re always sitting around, take time to get up, walk, bike, and stretch. Do what feels good and listen to your body.

Extra credit

Between ages 7 and 17 years, the spine can increase in length by about 26%.

Only performing “aerobic” workouts doesn’t seem to build spinal stabilization.

Tightness in the ITB and piriformis can limit pelvic movement.

Spinal compression is high during situps.

Lumbar flexibility tends to increase throughout the day.

Lateral deviation of the spine is known as scoliosis (when viewed from the front/back).

Using a Bodyblade correctly can actually enhance core stability

Further resources

Dr. Stuart McGill and BackFitPro

Exercises for low back pain

Core values – Preventing back pain

References

Schoenfeld BJ. Squatting kinematics and kinetics and their application to exercise performance. J Strength Cond Res 2010;24:3497-3506.

Lee J, Brook S, Daniel C. Back Pain – the facts. 2009. Oxford University Press.

Manire JT, et al. Diurnal variation of hamstring and lumbar flexibility. J Strength Cond Res 2010;24:1464-1471.

Kell RT & Asmundson GJG. A comparison of two forms of periodized exercise rehabilitation programs in the management of chronic nonspecific low-back pain. J Strength Cond Res 2009;23:513-523.

Sauer S & Biancalana M. Trigger point therapy for low back pain. 2010. New Harbinger Publications.

Kolber MJ & Fiebert IM. Addressing flexibility of the rectus femoris in the athlete with low back pain. Strength Cond J 2005;27:66-73.

Howley ET & Franks BD. Health Fitness Instructor’s Handbook. 4^th Ed. 2003. Human Kinetics.

Lower Back Savers Part 1:

http://www.tmuscle.com/free_online_article/sports_body_training_performance_repair/lower_back_savers

Lower Back Savers Part 2:

http://www.tmuscle.com/free_online_article/sports_body_training_performance_repair/more_lower_back_savers

Lower Back Savers Part 3:

http://www.tmuscle.com/free_online_article/sports_body_training_performance_repair/bulletproof_that_back

Kollias H. Core Values: Preventing back pain. Precision Nutrition. http://www.precisionnutrition.com/core-and-back-pain

Durstine JL & Moore GE. ACSM’s exercise management for persons with chronic diseases and disabilities. 2^nd Ed. 2003. Human Kinetics.

Durall CJ & Manske RC. Avoiding lumbar spine injury during resistance training. Strength Cond J 2005;27:64-72.

Ashton-Miller JA & Schultz AB. Biomechanics of the human spine and trunk. Exerc Sport Sci Rev 1988;16:169-204.

McGill SM, et al. Exercises for the torso performed in a standing posture: spine and hip motion and motor patterns and spine load. J Strength Cond Res 2009;23:455-464.

McGill S. Core training: Evidence translating to better performance and injury prevention. Strength Cond J 2010;32:33-47.

McGill SM. Low back stability: From formal description to issues for performance and rehabilitation. Exerc Sport Sci Rev 2001;29:26-31.

Kolber MJ & Beekhuizen K. Lumbar stabilization: An evidence-based approach for the athlete with low back pain. Strength Cond J 2007;29:26-37.

Ross MD. Preventing low back pain with athlete education and the prone press-up exercise. Strength Cond J 2007;29:78-80.

Harper TD. Protecting the spine during static stretching. Strength Cond J 1997;19:52-53.

Robinson EM. Overtraining the rectus abdominis can make you less efficient in weightlifting. Strength Cond J 2010:32:59-65.

Dreisinger TE. Strength training and low back pain. Strength Cond J 2003;25:56-59.

Frounfelter G. Selected exercises for strengthening the cervical spine in adolescent rugby participants. Strength Cond J 2008;30:23-28.

Nau E, Hanney WJ & Kolber MJ. Spinal conditioning for athletes with lumbar spondylolysis and spondylolisthesis. Strength Cond J 2008;30:43-52.

Greendale GA, et al. Yoga for women with hyperkyphosis: results of a pilot study. Am J Public Health 2002;92:1611-1614.

Greendale GA, et al. Yoga decreases kyphosis in senior women and men with adult-onset hyperkyphosis: results of a randomized controlled trial. J Am Geriatr Soc 2009;57:1569-1579.

Jeng CM, et al. Yoga and disc degenerative disease in cervical and lumbar spine: an MR imaging-based case control study. Eur Spine J 2010 Aug 15 (epub)

Williams K, et al. Evaluation of the effectiveness and efficacy of Iyengar yoga therapy on chronic low back pain. Spine (Phila Pa 1976) 2009;34:2066-2076.

Tekur P, et al. Effect of short-term intensive yoga program on pain, functional disability and spinal flexibility in chronic low back pain: a randomized control study. J Altern Complement Med 2008;14:637-644.

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You are a 35 year old man and your blood pressure is 120/80.

Congrats – your life expectancy is 76 years (assuming you are healthy otherwise).

Now imagine this:

You are a 35 year old man and your blood pressure is 150/91.

Bummer – your life expectancy is 55 years.

Might want to let your kids know about this.

What is high blood pressure?

Think of the water pipes in your house. The pressure in them allows water to flow to sinks, tubs, and washers. Similarly, we need pressure in our blood vessels so that blood can make its way to organs and tissues.

When you’re bumming around Walgreen’s late on a Saturday night and you decide to test your blood pressure, the result comes back as two numbers. The top number is the pressure in your arteries during a heartbeat. The bottom number is the pressure in your arteries while your heart is resting between beats.

How to interpret your blood pressure results

Our bodies can regulate blood pressure in various ways.

• Pressure receptors in organs adjust the force and speed of the heart’s contractions. For instance, when you go from lying down to standing, pressure receptors sense this and trigger a brief increase in heart rate to keep everything from sloshing into your feet.
• The kidneys and adrenal glands adjust components in blood that influence blood volume and fluid balance. Anti-diuretic hormone (ADH) decreases urine production. Aldosterone increases reabsorption of sodium (in exchange for potassium) from the urine, sweat, saliva, and intestinal secretions. This draws fluid back into your body and increases blood volume and blood pressure.
• Receptors in blood vessels adjust their size and elasticity.

Why is high blood pressure a problem?

Just like water pipes, if the pressure is too high or too low, you have problems. Imagine trying to use a garden hose to handle the pressure of a fire hose. That gives you an idea of what happens to your blood vessels.

If the pressure in your vessels is too high each time your heart contracts, damage can result.

• If this damage occurs to vessels of the eye, you could end up blind.
• If this damage occurs to vessels of the kidneys, you could end up on dialysis.
• If this damage occurs to vessels of the heart, you could end up with a heart attack.
• If this damage occurs to vessels of the brain, you could end up having a stroke or developing Alzheimer’s.
• If this damage occurs to vessels in the legs/arms, you could end up with peripheral vascular disease.

For each increment of 20 mm Hg (a measurement of blood pressure), cardiovascular disease risk doubles.

High blood pressure and preventable deaths

In 2005, 395,000 Americans died due to high blood pressure. In terms of individual risk factors for preventable health conditions, only smoking causes more deaths.

Preventable causes of death in the U.S. (Image source: Danaei G, et al. The preventable causes of death in the United States: comparative risk assessment of dietary, lifestyle, and metabolic risk factors. PLoS Med 2009;6:e10000058.)

High blood pressure doesn’t affect everyone equally. Your risk can also depend on your sex, age, and racial-ethnic background. For instance, women are more likely than men to suffer from high blood pressure if they are older.

Rates (% of each group) of high blood pressure, by sex and age (Source: Centers for Disease Control)

In the US, African Americans have far higher rates of high blood pressure than Mexican Americans or whites. Here again, women are slightly more likely to have high blood pressure… unless they are white.

Rates (%) of high blood pressure, by sex and racial-ethnic background (Source: Centers for Disease Control)

How to get high blood pressure under control

It’s pretty clear that high blood pressure is not only a health risk in and of itself, but it also signals the presence of other underlying health problems.

If you’re American, about 1 in 3 of you has high blood pressure. But you feel fine? That’s because high blood pressure doesn’t have any symptoms. You could be at risk without knowing it.

So let’s talk about controlling it. Luckily, the things that control blood pressure also keep you lean and fit. It’s win-win!

Lose body fat (or stay lean)

Rule #1 for controlling blood pressure is stay lean. Extra fat on the body needs extra blood vessels. And fat cells produce substances that promote inflammation throughout the vessels and heart. Use the eyeball test here. If you look fat, you are fat.

Move your body

Bad news – if you don’t regularly move your body, your risk of high blood pressure can go up by 60%. Any type of regular physical movement is helpful here (except moving your hand from the bag of chips to your mouth). Exercise seems to be even more important for men.

Doing structured workouts can be especially effective in helping to lower existing high blood pressure. We’re talking at least 5 hours of exercise per week. And (up to a point) more is likely better. Just because you clean up the bats for the company softball team doesn’t mean you are moving your body enough to control blood pressure — check yourself.

All forms of exercise are useful here (including short bouts, long bouts, and resistance training).

Intense exercise could be one of the best "preventive blood pressure medications" you can take

However, if you already suffer from high blood pressure, use caution: Maximal resistance training and using the Valsalva maneuver can bump up blood pressure during lifting. If blood pressure is a concern for you, opt for shorter sets with longer rests, and watch your heart rate between sets. (Maybe squat only six plates instead of eight.)

Exercise helps to control insulin levels. Less insulin means less sympathetic nervous system activation, less sodium reabsorption in the kidneys, and more elasticity in blood vessels. Exercise also makes your heart more efficient.

Exercise alone can lower blood pressure by nearly 4 mm Hg (even without any concurrent weight loss). A 5 mm Hg reduction in systolic BP can mean a 7% reduction in all-cause mortality. That’s a good first step.

Dump the boozing and smoking

Alcohol has a somewhat contradictory relationship with blood pressure. A little of the right type, enjoyed slowly and socially with a good meal, seems to help. About one alcoholic beverage per day — especially red wine — can lower blood pressure slightly (especially in women).

However, more is not better. Lots of booze leads to lots of blood pressure.

And if you guessed that binge drinking on an empty stomach might not help control blood pressure, you are correct. High alcohol intake can:

• activate the sympathetic nervous system
• activate the renin-angiotensin-aldosterone system (which controls fluid levels in the body)
• increase levels of stress hormones such as cortisol
• decrease production of nitric oxide (which normally helps relax blood vessels, so if you have less nitric oxide, your blood vessels are going to be as pliable as frozen rubber)

These are all bad things for controlling blood pressure.

We all know smoking is bad. Smoking increases blood pressure, so you might want to find a new hobby.

Improve your nutrition

Diets built around whole, unprocessed plant foods can help control blood pressure. People with existing high blood pressure who add more plants to their diets can lower blood pressure into a healthy range — even if they don’t lose weight.

Eating more plants improves your intake of arginine, lycopene, folate, fibre, magnesium, potassium, sulfur, and vitamins C and E. All of these nutrients play a role in controlling blood pressure.

But wait a second, what if someone just consumed a Western diet while supplementing the aforementioned nutrients? Well, this might help a smidge, but not enough to impress your blood vessels.

Here are 8 important dietary changes you can make to lower your blood pressure.

1. Consume 1-2 servings of lower fat dairy each day.

Higher fat dairy doesn’t seem to have the same effect. Some studies suggest that dairy might help to moderate insulin levels, although the evidence is mixed — other studies have shown that dairy can be insulin-stimulating. Additionally, research suggests that peptides released with cow’s milk can inhibit angiotensin converting (ACE) enzyme, while a clinical trial showed that hydrolysate of casein lowered arterial blood pressure.

2. Get plenty of lean protein.

Protein dense foods help control insulin release. Plant proteins like beans/legumes are also good substitutes for more refined carbohydrates.

3. Consume at least 3 servings of intact whole grains each day.

This means whole grains such as brown rice, whole oat groats, sprouted grain bread, quinoa, etc. Whole grains can improve blood vessel elasticity.

4. Consume 10-30 grams/day of dark chocolate.

Compounds in cocoa may help blood vessel elasticity. Plus, it makes you feel groovy, and reducing stress is a great way to lower blood pressure!

5. Get enough vitamin D.

Vitamin D deficiency is associated with high blood pressure. Get blood levels tested and supplement if necessary. And get outside for some sunlight, cubicle moles! See All About Vitamin D for more.

6. Balance your fat intake.

Get plenty of omega-3s from oily fish (and other marine life), wild-caught game meats, and flax (ALA, EPA and DHA all seem to help – see here for more: All About Healthy Fats). High omega-3 intake is linked to lower blood pressure, likely because of omega-3s influence on eicosanoid production, which helps control vessel dilation and platelet aggregation.

7. Cut the sugar.

Americans eat about 22 teaspoons of added sugar per day, which might be contributing to our rampant high blood pressure. Excess sugar can make us fat, which can lead to high blood pressure.

And eating lots of added sugars may also activate the sympathetic nervous system, decrease urinary sodium excretion, increase sodium absorption in the GI tract, and decrease blood vessel nitric oxide. Not good.

8. Supplement wisely — once your diet is excellent.

Once you have everything else under control, you can look into supplementing things like Coenzyme Q10 and/or garlic.

Cut sodium intake…

It’s well established that dietary salt plays a role in regulating blood pressure. More sodium means higher blood pressure; conversely, lowering sodium lowers blood pressure too.

But don’t fear sprinkling a little salt into your homemade lentil soup. When we talk about over-salted Americans, we’re talking about processed foods and restaurants. About 80% of the sodium we consume comes from processed foods.

Going from standard salt-laden American eating (about 6,000 mg of sodium per day) to consuming under 2300 mg of sodium per day can lower blood pressure 10 points in hypertensive folks, without any other changes.

…but not too much

We need some sodium, especially if we’re active. We need at least half a teaspoon of salt each day for normal functioning. If you are really fit and lean, you can get by with about 1 teaspoon of daily added salt.

Cutting salt too much when you don’t need to isn’t a good idea. If you exercise and sweat a lot, you need more. And folks getting restrictive with salt intake are at risk for iodine deficiency. For more on sodium, see All About Sodium.

Many folks get hyper-focused on salt when it comes to blood pressure. But we all respond to it differently. A high salt intake is usually just a symptom of a crappy overall diet – too many processed foods, sugar, dairy, meat – and not enough vegetables, fruits, beans, whole grains and nuts/seeds (potassium from plant foods helps to balance the effects of sodium and keep blood pressure in check).

Yoga, meditation and stress

If you’re always stressed, your blood pressure is probably elevated.

Deep breathing, yoga, and meditation can immediately lower blood pressure by several points. But it’s not enough to be stressed out all week and hit a Sunday yoga class. You need to relax more overall. Five minutes of deep breathing can only do so much when the other 10,075 minutes in your week are hectic.

So make it a priority to chill out. Pet a dog, see a therapist, take a nature walk, meditate, listen to music, do yoga, see a comedian, or anything else that helps you get mellow. Your health may depend on it.

Summary and recommendations

Blood pressure can almost always be controlled with lifestyle changes. Just remember, small changes = small results. Big changes = big results.

• Stay lean. If you look fat, you are fat.
• Get 5 hours/week of exercise. At least some of it should be vigorous.
• Move around during the day. Use your body to get places.
• If you drink alcohol, keep it around one drink per day. Wine is best, and try to consume it with meals.
• Don’t smoke.
• When you sit down to eat, make sure that most of your plate/bowl is filled with vegetables, fruits, beans/peas, intact whole grains, and nuts/seeds. Including small amounts of lower fat dairy and dark chocolate each day might help.
• If you regularly eat added sugars and salt, your diet probably sucks. Cut them where you can and replace with veggies or fruits.
• Consume oily fish and other marine life. Mix in some flax seeds, hemp seeds, chia seeds or walnuts to get your dietary omega-3’s.
• If you are vitamin D deficient, use a supplement. Get outside in the sun.
• Bust stress. Do yoga, breathe deeply, connect with loved ones, laugh.

Extra credit

Lots of caffeine can bump up blood pressure. Though tea and coffee have mixed results on blood pressure (probably due to genetic differences in caffeine metabolism), you don’t need to chug them anyway.

Different types of religious fasts seem to have variable effects on blood pressure. No style of fasting appears to have a clear benefit.

Binge drinking increases both systolic and diastolic blood pressure by about 5 mm Hg during the time of intoxication.

Systolic blood pressure readings in excess of 300 mm Hg have been recorded during the leg press. In the 1-3 hours after exercise, systolic blood pressure tends to decrease by 10-20 mm Hg. This can last up to 9 hours. So if you’ve ever stood up too fast after a set of heavy squats or while cooling down from a workout and felt dizzy/saw floaters, then you’ve experienced this.

Early AM hours and cold weather can result in a higher blood pressure.

Certain medications can raise blood pressure – check with your doc.

The blood pressure levels of purely vegetarian Trappist monks were found to be lower than those of Benedictine monks, who consume a Western diet.

Adding more meat to a plant-based diet increases blood pressure, possibly from the “substitution effect” (swapping out blood pressure lowering plant foods).

References

Elmer PJ, et al. Effects of comprehensive lifestyle modification on diet, weight, physical fitness, and blood pressure control: 18-month results of a randomized trial. Ann Intern Med 2006;144:485-495.

He FJ & MacGregor GA. Effect of longer-term modest salt reduction on blood pressure. Cochrane Database Syst Rev 2004(3):CD004937.

He FJ, Markandu ND, MacGregor GA. Modest salt reduction lowers blood pressure in isolated systolic hypertension and combined hypertension. Hypertension 2005;46:66-70.

Dumler F. Dietary sodium intake and arterial blood pressure. J Ren Nutr 2009;19:57-60.

Craig WJ, Mangels AR: American Dietetic Association. Position of the American Dietetic association: vegetarian diets. J Am Diet Assoc 2009;109:1266-1282.

Al-Solaiman Y, et al. DASH lowers blood pressure in obese hypertensives beyond potassium, magnesium and fibre. J Hum Hypertens 2010;4:237-246.

Berkow SE & Barnard ND. Blood pressure regulation and vegetarian diets. Nutr Rev 2005;63:1-8.

Suter PM, et al. Nutritional factors in the control of blood pressure and hypertension. Nutr Clin Care 2002;5:9-19.

Miura K, et al. Relation of vegetable, fruit, and meat intake to 7-year blood pressure change in middle-aged men: the Chicago Western Electric Study. Am J Epidemiol 2004;159:572-580.

Steffen LM, et al. Associations of plant food, dairy product, and meat intakes with 15-y incidence of elevated blood pressure in young black and white adults: the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Am J Clin Nutr 2005;82:1169-1177.

Djousse L, et al. Dietary linolenic acid is associated with a lower prevalence of hypertension in the NHLBI Family Heart Study. Hypertension 2005;45:368-373.

Djousse L, et al. Influence of saturated fat and linolenic acid on the association between intake of dairy products and blood pressure. Hypertension 2006;48:335-341.

Malinski MK, et al. Alcohol consumption and cardiovascular disease mortality in hypertensive men. Arch Intern Med 2004;164:623–628.

Taylor B, et al. Alcohol and hypertension: gender differences in dose-response relationships determined through systematic review and meta-analysis. Addiction 2009;104:1981-1990.

Alkerwi A, et al. Alcohol consumption and the prevalence of metabolic syndrome: a meta-analysis of observational studies. Atherosclerosis 2009;204:624-635.

Sesso HD, et al. Alcohol consumption and the risk of hypertension in women and men. Hypertension 2008;51:1080-1087.

Field AE, et al. Impact of overweight on the risk of developing common chronic diseases during a 10-year period. Arch Intern Med 2001;161:1581-1586.

Hernelahti M et al. Stability and change of volume and intensity of physical activity as predictors of hypertension. Scand J Public Health 2004;32:303-309.

Barengo NC, et al. Low physical activity as a predictor for antihypertensive drug treatment in 24-64-year-old populations in eastern and south-western Finland. J Hypertens 2005;23:293-299.

Nakanishi N & Suzuki K. Daily life activity and the risk of developing hypertension in middle-aged Japanese men. Arch Intern Med 2005;165:214-220.

Madero M, et al. Dietary fructose and hypertension. Curr Hypertens Rep 2010 Oct 19 (epub ahead of print)

Trepanowski JF & Bloomer RJ. The impact of religious fasting on human health. Nutr J 2010;9:57.

Nguyen S & Lustig RH. Just a spoonful of sugar helps the blood pressure go up. Expert Rev Cardiovasc Ther 2010;11:1497-1499.

Kowalski RE. The Blood Pressure Cure. 2007. John Wiley & Sons, Inc. New Jersey.

Appel LJ, et al. Effects of protein, monounsaturated fat, and carbohydrate intake on blood pressure and serum lipids: results of the OmniHeart randomized trial. JAMA 2005;294:2455-2464.

Tayie FA & Jourdan K. Hypertension, dietary salt restriction, and iodine deficiency among adults. Am J Hypertens 2010;23:1095-1102.

Danaei G, et al. The preventable causes of death in the United States: comparative risk assessment of dietary, lifestyle, and metabolic risk factors. PLoS Med 2009;6:e10000058.

Tighe P, et al. Effect of increased consumption of whole-grain foods on blood pressure and other cardiovascular risk markers in healthy middle-aged persons: a randomized controlled trial. Am J Clin Nutr 2010;92:733-740.

Gorden-Larsen P, et al. Active commuting and cardiovascular disease risk: the CARDIA study. Arch Intern Med 2009;169:1216-1223.

von Huth Smith L, et al. Commuting physical activity is favourably associated with biological risk factors for cardiovascular disease. Eur J Epidemiol 2007;22:771-779.

Houston M, Fox B, Taylor N. What your doctor may not tell you about hypertension. 2003. Warner Books. New York.

Brewer S. Overcoming high blood pressure. 2008. Duncan Baird Publishers. London.

Saptharishi L, et al. Community-based Randomized Controlled Trial of Non-pharmacological Interventions in Prevention and Control of Hypertension among Young Adults. Indian J Community Med 2009;34:329-334.

Singh S, et al. Role of yoga in modifying certain cardiovascular functions in type 2 diabetic patients. J Assoc Physicians India 2004;48:461–465.

Schwickert M, et al. Stress management in the treatment of arterial hypertension. MMW Fortschr Med 2006;148:40–42.

Aivazyan TA, et al. Efficacy of relaxation techniques in hypertensive patients. Health Psychol 1988;7:193–200.

Damodaran A, et al. Therapeutic potential of yoga practices in modifying cardiovascular risk profile in middle aged men and women. J Assoc Physicians India 2002;50:633-640.

Ospina MB, et al. Meditation practices for health: state of the research. Evid Rep Technol Assess (Full Rep) 2007;155:1-263.

Rainforth MV, et al. Stress reduction programs in patients with elevated blood pressure: a systematic review and meta-analysis. Curr Hypertens Rep 2007;9:520-528.

Nidich SI, et al. a randomized controlled trial on effects of the Transcendental Meditation program on blood pressure, psychological distress, and coping in young adults. Am J Hypertens 2009;22:1326-1331.

Chiesa A. Zen meditation: an integration of current evidence. J Altern Complement Med 2009;15:585-592.

Nahas R. Complementary and alternative medicine approaches to blood pressure reduction: An evidence-based review. Can Fam Physician 2008;54:1529-1533.

Durstine JL & Moore GE. ACSM’s exercise management for persons with chronic diseases and disabilities. 2nd Ed. 2003. Human Kinetics.

Savica V, et al. The effect of nutrition on blood pressure. Annu Rev Nutr 2010;30:365-401.

Yang YC, et al. The protective effect of habitual tea consumption on hypertension. Arch Intern Med 2004;164:1534-1540.

Taubert D, et al. Effect of cocoa and tea intake on blood pressure: a meta-analysis. Arch Intern Med 2007;167:626-634.

Geleijnse JM. Habitual coffee consumption and blood pressure: an epidemiological perspective. Vasc Health Risk Manag 2008;4:963-970.

Higdon JV & Frei B. Coffee and health: a review of recent human research. Crit Rev Food Sci Nutr 2006;46:101-123.

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What is acupuncture?

Acupuncture originated in China nearly 2500 years ago as a holistic therapy meant to treat the whole patient rather than a specific condition. The earliest acupuncture tools were sharp pieces of stone, flint, bones or bamboo.

While it’s become one of the most popular complementary therapies worldwide, it didn’t gain popularity in the West until the 1970s.

How is acupuncture performed?

Acupuncture involves puncturing the skin with a needle, but can include other types of stimulation to the epidermis. Modern acupuncture can also include electrostimulation through the inserted needles. The purpose of needle insertion is to alter the flow of Chi (or Qi) through body meridians. (More on Chi below.)

When needles are used as a method of treatment, they vary in size and length. Most are about one inch long. Needles up to three inches long can be used in fleshy areas like the glutes. To lower disease transmission, one-time disposable needles should be used.

Needle insertion can be just under the skin or into the muscle and can produce a mild ache or sense of heaviness, but is rarely sharply painful. Needles are usually left in place for 15 to 30 minutes. Between six and eight treatments might be required to detect any results, although patients may notice some immediate effects.

Balancing Chi

In traditional Chinese medicine (TCM), the normal flow of body energies or life force is called Chi (or Qi), and it’s in a constant state of flux. It’s thought that Chi circulates through meridians (energy pathways), just as blood circulates through vessels.

Unlike modern Western medicine, which focuses on “curing” disease symptoms, traditional Chinese medicine focuses on achieving a dynamic balance between the various elements that make up each person. Traditional practitioners claim that when Chi is out of balance, illness results. It’s been said that humans are born with a certain allotment of Chi, which we replenish with food and air.

TCM practitioners also look at the opposing but complementary forces of yin and yang. Yin pertains to cold, slow, dark, and quiet; it’s sometimes viewed as a “feminine” energy. Yang is hot, fast, bright, and loud; it’s sometimes viewed as a “masculine” energy.

According to TCM, yin and yang must be balanced to maintain optimal health. Chi can be bi-directional according to the yin or yang energy — for instance, raising or lowering blood pressure; increasing or decreasing gastric secretions, etc. It’s thought that acupuncture promotes this balance by using the body meridians through which Chi flows. There are 12 pairs of meridians associated with organs, joints and extremities. There is no known evidence for physical existence of these meridians.

Image source: Berman B, et al. Acupuncture for chronic low back pain. NEJM 2010;363:454-461.

Each meridian has five acupuncture points related to the five Chinese elements – earth, wood, water, metal and fire (not related to the periodic table of elements).

It’s thought that needling the meridian can improve the condition of the associated organ. Some of the meridian relationships are apparent, like the bladder relating to water. But some aren’t, like wood relating to the liver.

Harmful Chi is thought to contribute to illness and can arise from internal and external sources. Examples include wind, cold, heat, wetness, dryness, joy, anger, melancholy, obsessions, grief, fear, fright, irregular eating, excessive stress, lack of exercise, and trauma.

The flow of Chi is controlled by a biological clock allowing practitioners to assess the timing of symptoms (along with the actual symptoms) to get an idea of the organ affected. For example, if someone had a cough, asthma or tightness in the chest, it may be due to an excess or deficiency of lung meridian Chi, especially if the symptoms are noticed early in the morning when the lung meridian has a surge of energy.

Also, the pulse and tongue are checked by the acupuncturist to diagnose the flow of Chi and organ status.

Modern Western medicine’s interpretation

Modern medicine has proposed 5 interacting explanations for how acupuncture works.

1 – Local

Acupuncture may stimulate nerve fibers in the skin and muscles, triggering action potentials and the release of substances that can dilate vessels (increasing local blood flow). This may help to encourage tissue healing.

Source: Wang GJ, et al. Meridian studies in China: A Systematic Review. J Acupunc Meridian Stud 2010;3:1-9.

2 – Segmental

The action potentials that are triggered by the needle insertion can travel along the nerve and depress responses to painful stimulus, in part due to enkephalin release. This is likely the reason for pain relief. And when it comes to pain relief, some data indicate acupuncture can be as effective as morphine!

3 – Extrasegmental

Action potentials can go a long way. They can make their way up to the brain and stimulate the body’s pain-suppressing operations, in part due to endorphin release. This result doesn’t depend so much on needling specific areas of the body, rather, just getting enough nerve stimulation.

4 – Central regulatory

The hypothalamus and limbic system can be stimulated by acupuncture, which may have an overall calming effect and regulate the autonomic nervous system.

5 – Myofascial trigger points

We hear about myofascial release using foam rollers and tennis balls, but acupuncture can influence the fascia too. Small knots can form in tight muscles with repetitive use or injury. These knots might act as protective mechanisms ensuring the muscle rests/recovers, or it might just be a healing malfunction in the body. Either way, fascial knots are sensitive and acupuncture can help in their release. Moving the muscle through a full range of motion after treatment may assist in recovery.

The clinical data

Acupuncture sounds great – but isn’t it all just anecdotes? Is any of this legit science?

Evidence from clinical trials indicates that acupuncture isn’t just a placebo effect. Still, rigorous trials are difficult since it’s hard to mimic a needle or perform a “sham” puncture in blind studies, especially in cultures familiar with the practice.

Clinical research suggests that acupuncture is helpful for:

• Relief of nausea and vomiting
• Relief of back pain
• Relief of chronic knee pain
• Relief of post-operative dental pain

Beyond these areas, research hasn’t been accomplished, isn’t conclusive, or has shown no effect.

Data indicates that acupuncture is safe when a skilled practitioner is performing the treatment. Mild adverse events might include bleeding and drowsiness. Significant events are uncommon but might include infections, nerve/vessel injury, exacerbations of asthma, and seizure. All treatments should be performed lying down, due to the potential of fainting. Always avoid the use of embedded needles and self-acupuncture.

My acupuncture experience

While researching this article, I figured I should experience the world of acupuncture. Since I currently don’t have any illnesses or complaints, I requested a “general health” session, focusing on tendonitis (medial elbow) and cold hands (since I maintain a lean body year round, I’ve noticed colder extremities).

The practitioner showed me the needles (36 gauge, single-use disposable), explained her procedure, examined my pulse and tongue, and then moved forward with needle insertion.

She inserted one needle in each foot, two needles in each calf, two needles in my upper abdomen, one needle by each thumb, and one needle inside each elbow. Oh – and one needle in my forehead for relaxation.

I definitely felt all the punctures, and the needles on the right side of my abdomen, thumb, and calf resulted in some sharp and lingering pains. The practitioner told me this was Chi. I think it was my nerve endings.

After all the needles were inserted the practitioner told me to relax and take myself to a calm place. She turned off the lights and then left for about 12 minutes.

I wasn’t very relaxed because I didn’t want to move my body and bump a needle insertion. Also, my scalp started itching and I couldn’t itch it because I didn’t want to jam a needle into my head.

Let me be straight — I’m fine with needles. I donate blood, I’ve been certified in venipuncture, and I’ve even injected myself with veterinary vitamins when I was bodybuilding (don’t ask about it and don’t try it). But something about multiple small needles in my body at one time didn’t go very well. If you don’t like needles, you probably won’t like acupuncture.

When the practitioner returned, she explained that it can take up to 12 treatments to notice relief, depending on the ailment being addressed. She said my flow of Chi, pulse, and tongue were excellent. That’s always nice to hear.

I had very minimal bleeding at two of the insertion sites and there was some lingering dull pain in my calf, thumb and abdomen after leaving.

Keep in mind that I completed the acupuncture treatment for “general health,” and I don’t think the potential benefits outweighed the discomfort and cost ($75 for 90 minutes). I probably wouldn’t pursue acupuncture again unless I had a specific health concern.

Summary and recommendations

It’s difficult to draw strong conclusions since the acupuncture experience tends to be governed by social and psychological factors.

Acupuncture might be useful for the relief of nausea and vomiting, and some forms of pain relief. The effects seem to take place locally, along nerve segments, centrally, and at fascial trigger points.

Acupuncture does appear to be safe when working with an experienced practitioner. If you seek treatment, make sure to find a legit professional, see here for more: nccaom.org

Extra credit

Tattoo marks found on prehistoric human remains may have had a medical purpose similar to acupuncture. This was discovered around 3300 BC.

An unhealthy tongue can indicate buildup of harmful Chi.

One of the most respected medical universities in Canada, McMaster University, also offers a medical acupuncture program.

Semi-permanent acupuncture needles placed into the rim of the ear (see image below) have been used in the military to decrease pain.

Image source: Ambron T. The ancient art of acupuncture is new again. JAAPA 2010;23:51-52.

Further resources

More on the Chinese elements

References

World Health Organization. Acupuncture: review and analysis of reports on controlled clinical trials. Geneva. 2002.

Kidson RL. Is acupuncture right for you? Healing Arts Press. 2008.

White A, Cummings M, Filshie J. An introduction to western medical acupuncture. Churchill Livingstone Elsevier. 2008.

Miyamoto S, et al. Risks and causes of cervical cord and medulla oblongata injuries due to acupuncture. World Neurosur 2010;73:735-741.

Wang T, et al. A systematic review of acupuncture and moxibustion treatment for chronic fatigue syndrome in China. Am J Chin Med 2008;36:1-24.

Cheuk DK, et al. Acupuncture for insomnia. Cochrane Database Syst Rev 2007;3:CD005472.

Green S, et al. Acupuncture for lateral elbow pain. Cochrane Database Syst Rev 2002;1:CD003527.

Green S, et al. Acupuncture for shoulder pain. Cochrane Database Syst Rev 2005;2:CD005319.

Cheuk DK & Wong V. Acupuncture for epilepsy. Cochrane Database Syst Rev 2006;2:CD005062.

La Touche R, et al. Acupuncture in the treatment of pain in temporomandibular disorders: a systematic review and meta-analysis of randomized controlled trials. Clin J Pain 2010;26:541-550.

Cho SH, et al. Acupuncture for obesity: a systematic review and meta-analysis. Int J Obes (Lond) 2009;33:183-196.

Trigkilidas D. Acupuncture therapy for chronic lower back pain: a systematic review. Ann R Coll Surg Engl 2010;92:595-598.

Cho SH, et al. Acupuncture for pain relief in labour: a systematic review and meta-analysis. BJOG 2010;117:907-920.

Cho SH & Kim J. Efficacy of acupuncture in management of premenstrual syndrome: a systematic review. Complement Ther Med 2010;18:104-111.

Ambron T. The ancient art of acupuncture is new again. JAAPA 2010;23:51-52.

Berman B, et al. Acupuncture for chronic low back pain. NEJM 2010;363:454-461.

Wang GJ, et al. Meridian studies in China: A Systematic Review. J Acupunc Meridian Stud 2010;3:1-9.

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1. A cardiac catheterization
2. A Cinnamon Toast Crunch-induced coma
3. A kidney stone

Needless to say, I was excited to write this article.

What are kidney stones?

Kidneys make clean blood by eliminating wastes.

For instance, if you eat a can of soup with lots of salt, the kidney will excrete more salt to balance out levels in the body. If you eat a big steak, more urea will be excreted in the urine.

If the body is unable to eliminate these wastes, you get sick. (Here’s a primer on the urinary system.)

Our kidneys eliminate waste products through urine, and when there is excessive waste or not enough fluid volume, urine becomes supersaturated and a stone can form. Stones can be tiny like a grain of sand or big like a golf ball.

Three things you never want in your kidneys: a dime, a kidney stone, and a safety pin

Stones can hang out in the kidneys for years without obstructing any tubing. But when a stone obstructs the ureter, serious pain follows (it’s been said that kidney stones are the worst pain imaginable). The pain can stop/start as the stone heads to the bladder. The bladder tunnel is where most stones get hung up. Since stones may have sharp edges, they can draw blood into the urine.

Kidney stone types

There are four main types of kidney stones:

1. Calcium-containing stones – these make up a majority, nearly 75% of stones
2. Uric acid stones – these make up about 10% of stones
3. Struvite (infected) stones – these make up about 10% of stones and form after an infection in the urinary tract
4. Cystine stones – these are stones that form from the amino acid cystine, the most uncommon

The table below shows the composition, frequency, and causes of kidney stones, aka nephrolithiasis (nephro = kidney; lith = stone).

Source: Hall PM, Nephrolithiasis: Treatment, causes, and prevention. Clev Clin J Med 2009;76:583-592.

Why are kidney stones important?

Kidney stones are increasingly common, especially in industrialized and more affluent countries.

By 70 years of age, about 11% of American men and 6% of American women will have had a symptomatic kidney stone. The incidence of kidney stones in the U.S. jumped by nearly 35% between 1980 and 1994 (side note: this increase parallels the rise in obesity).

Lifetime expectancy for kidney stones, men aged 60-70, by country. (KSA: Kingdom of Saudi Arabia; UAE: United Arab Emirates)

Kidney stones and chronic diseases

Several factors seem to affect people’s risk of kidney stones.

For one thing, kidney stones can be a sign of other diseases. Most stone formers also have things like:

• lipid abnormalities
• cardiovascular disease
• type 2 diabetes
• high blood pressure
• excess body fat
• gout

High blood pressure in particular doubles the risk of stones, since it changes how calcium is absorbed in the kidneys.

Diet and kidney stones

Doctors think that people who form stones lack specific chemicals in the urine to prevent them. That’s the bad news. The good news is that these folks can modify what they eat/drink to control stone formation. About two-thirds of people can limit stone formation with basic dietary modifications.

The six major dietary factors in kidney stone formation are:

1. Hydration
2. Animal protein intake
3. Calcium
4. Oxalate
5. Sodium
6. Extreme diets

Factor 1: Hydration

Hydration is probably the most studied area relating to kidney stones. It makes sense: getting enough fluid consistently is vital for stone prevention.

Urine is composed of water, salt, urea, oxalate, uric acid, potassium, magnesium, calcium, oxalate, creatinine, and other acids/waste products of metabolism. The composition of urine changes based on what we ingest. If we don’t drink enough water, or eat excessive amounts of rich foods, the urine becomes more concentrated, which can increase the odds of stone formation.

Concentrated urine can result from someone not drinking enough water, sweating a lot, or eating a rich diet (or a combination of all these factors). When you sweat a lot, you are losing fluid by another means, so you’ll urinate less.

In theory, even if your diet was extremely concentrated in rich foods, if your urine was always dilute, you probably wouldn’t form stones (but you may suffer from hyponatremia).

What you drink can also be a factor.

This is because citrate inhibits calcium stones. We make citrate in the kidney when urinary pH is alkaline.

Potassium citrate found in lemons (and other fruits and vegetables) can increase urinary citrate, which can protect against kidney stones. But citric acid, which is added to many soft drinks, doesn’t appear to be protective. Apple juice, grapefruit juice, cranberry juice, and cola drinks seem to increase the risk of forming stones. Fruit-flavoured soft drinks don’t seem to have this negative effect (including drinks like Gatorade). Naturally carbonated mineral water acquires carbonation from dissolved limestone and can contribute to kidney stone formation.

Thus, water and liquid from whole foods (such as lemons) is ideal.

You should get a minimum of 2 litres of liquid per day (either from water or in foods) to produce adequate urine volume (you want about 2 litres of urine volume). Hydration needs fluctuate with body size, climate, physical activity, etc. — if you’re bigger, warmer, and/or working harder, you’ll want more fluid.

Factor 2: Animal protein

Beyond hydration, a high animal protein intake is probably the most important factor influencing kidney stone development. Why? A few reasons:

1. Animal protein contains purines (well, some plant foods do too, but it appears that purines from plants don’t seem to have the same effects in the body). We break down purines into uric acid. Some of this in the body is fine, but too much can supersaturate the urine and lead to stones (both uric acid and calcium-containing types).
2. Animal protein makes the urine more acidic, leading to less solubility for uric acid, and suppression of citrate formation. If you don’t consume enough alkaline-forming fruits and veggies, this means trouble.
3. Animal protein contains high amounts of glycine and methionine. Glycine is metabolized into oxalate, and methionine can increase urinary calcium.

Data has indicated that those who eat a plant-based diet tend to have a lower incidence of kidney stones, even when including more oxalate-rich plants. Plant-based eaters form stones at about 1/3 the rate of those eating an omnivorous diet. This may be due to the higher intake of citrate-rich foods on a plant-based diet, which can make the urine more alkaline (and help prevent stone formation).

One study demonstrated a 33% increased risk of kidney stones with a 77 gram versus a 50 gram animal protein diet (some people eat this much animal protein per meal). Another trial showed that a diet low in animal protein (52 g/day), sodium (50 mmol/day), and oxalate (200 mg/day), with normal calcium intake (1200 mg/day) was associated with a reduction in stone formation of almost 50% over a five year period.

It’s important not to restrict protein below 0.8 g/kg body weight per day (so, for someone who weighs 180 pounds, this would be about 65 grams of protein per day), as this can increase parathyroid hormone and calcium in the urine.

For more on acid-base balance, see All About Dietary Acids and Bases.

Factor 3: Calcium

When we consume and absorb high levels of calcium, we must excrete the excess. One way to excrete calcium is via urine. Higher levels of calcium in the urine can increase the chances of kidney stones for certain individuals (calcium is the most abundant mineral in kidney stones).

While excessive calcium intake isn’t a good idea, a low calcium diet might be even worse.

First, not getting enough calcium can harm bone health.

Second, eating calcium rich foods can help bind oxalates in the gut (see below for more on oxalates) and get rid of them in the stool (before they’re absorbed and travel to the kidneys).

Finally, a low calcium intake leads to bone breakdown and higher levels of calcium in the urine.

What about calcium supplements?

Well, when calcium isn’t bound to natural co-factors in food, the delivery system is altered, and the calcium may end up in places we don’t want (e.g., calcification in vessels and kidneys). Further, the body might attempt to relieve itself of the elemental calcium by pushing it through the kidneys (resulting in stones).

If you supplement with calcium, balance your intake with foods, only use calcium citrate, make sure vitamin D status is controlled (not too high or too low), and consume supplements with meals.

About 800 – 1000 mg per day of calcium should be plenty (total – from food and supplements).

Factor 4: Oxalates

Oxalic acid is a naturally occurring substance that can bind with minerals. Oxalates are kind of boring, well, until they crystallize with calcium to form kidney stones.

When someone has lots of oxalates in their urine, where the heck did they come from? Well, there are five potential sources of oxalates:

1. Oxalate-rich plant foods
2. Waste products of general metabolism
3. Vitamin C supplements
4. Animal protein
5. Beverages

Source #1: Oxalate-rich plant foods

Oxalate content in plants can vary because of differences in climate, soil, ripeness, or section of the plant analyzed. Younger plants have more oxalic acid, which we absorb more of. Older plants have formed calcium oxalate salts, which we absorb less of.

Foods higher in oxalates include:

• spinach
• rhubarb (the leaves are so high in oxalates they are poisonous)
• beets
• amaranth
• Swiss chard
• chives
• parsley
• cocoa
• berries
• bran
• nuts

Panicked yet? Don’t worry — dietary variety is your friend.

Swap out kale for spinach. Don’t eat rhubarb leaves. Only eat beets during the peak season. Lots of cocoa means lots of chocolate, and if you are consuming it regularly, you’ll have problems beyond kidney stones. Incorporate pumpkin seeds, sunflower seeds, flax seeds, and macadamia nuts in place of higher oxalate nuts/nut butters.

Seasonal eating can help control oxalate intake. Some people eat spinach and berries year round. Holy oxalates. Instead, each spinach and berries only during peak seasons. During the other months, switch to lower-oxalate foods like cauliflower and apples.

A “normal” day of eating might include 80-100 mg of oxalate/day, and we only absorb about 10-20% of that.

After oxalates are absorbed, the only way to get rid of them is in the urine.

Excreting excessive amounts of oxalates in the urine is called hyperoxaluria, and it’s unlikely that you’ll end up with that from dietary intake alone. Rather, it’s from overabsorption in the gut (more oxalates are absorbed in the gut when someone is suffering from inflammatory bowel disease), low dietary calcium intake (remember, calcium binds oxalates in the gut), low fibre intake, and endogenous production.

Oxalates from food are tricky. Some data even indicates no added risk for stone development from oxalate-rich food.

Source #2: Waste products of general metabolism

Normal metabolic processes in the body contribute to oxalate formation.

Vitamin B6 (pyridoxine) is a cofactor in the conversion of glyoxylate to glycine, and its deficiency could increase oxalate production in the body. So get enough vitamin B6 from sources like whole wheat, brown rice, green leafy vegetables, sunflower seeds, potato, garbanzo beans, banana, spinach, tomatoes, avocado, walnuts, peanut butter, lima beans, and bell peppers.

Source #3: Vitamin C supplements

Vitamin C supplements (ascorbic acid) can be metabolized to oxalic acid once ingested.

Source #4: Animal protein

When we use amino acids as an energy source, oxalate synthesis can result. Also, data indicates that a precursor to oxalate, called glycolate, might increase as we consume more animal protein. Still, these results are variable based on what type of stones the person tends to form.

Metabolic pathways from meat proteins to oxalates

Source: Nguyen QV, et al. Sensitivity to meat protein intake and hyperoxaluria in idiopathic calcium stone formers. Kidney Int 2001;59:2273-2281.

Source #5: Beverages

Cola soft drinks may lead to higher levels of oxalates in urine, while decreasing magnesium and citrate. Bad news if you like your kidneys. Still, some data indicates that caffeine and sugar-free colas don’t have any negative influence on stone formation.

Those who drink small amounts of coffee, alcohol, and tea may have a lower risk of kidney stones, even though these beverages can contain oxalates. Drinking coffee/tea with milk can further bind oxalates and prevent absorption (this is due to calcium, so any non-dairy milk fortified with calcium would work). Green teas, rooibos teas, and herbal teas tend to contain less oxalate than black teas.

Excessive sugar consumption (from food or drink) may lead to increased oxalate, calcium, and uric acid in the urine.

Factor 5: Sodium

As we increase sodium in the diet, urinary calcium excretion increases, and this can influence stone formation.

By now, most everyone knows (I hope) that we get most of our sodium from processed foods. Limiting sodium to less than 2300 mg per day — simply by switching to unprocessed, whole foods — can greatly decrease the amount of oxalate and calcium in the urine, both extremely helpful in preventing stones.

A note on sodium: if small amounts of sodium in a beverage help someone keep fluid intake at 2 litres per day, the benefits of more fluid outweigh the risks of more sodium.

Factor 6: Extreme diets

We know that yo-yo diets are a great way to form gallstones, but risk for kidney stones also goes up.

Large meals and binge eating, especially at night before sleep, can lead to very concentrated urine. Further, with yo-yo dieting we repeatedly break down stored body fat for energy, leading to metabolic by-products (including ketones) that must filter through the kidneys. These by-products tend to make the urine more acidic, which can lead to stones.

Lower-carb, higher-fat/protein diets can increase urinary acidity, lower urinary citrate, and raise urinary calcium – increasing the chances of kidney stone formation.

Factors beyond our control

Genetics

Kidney stones tend to run in families. If you have a relative with kidney stones, your risk is 2-3 times higher of getting one. Specific factors have been associated with this.

Alanine:glyoxylate aminotransferase (AGT) is a vitamin B6 (pyridoxine) dependent enzyme found in the liver that converts glyoxylate to glycine, reducing the formation of oxalate from glyoxylate.

A genetic variation can result in more AGT in the mitochondria rather than perioxisomes. Peroxisomes deal more effectively with plant-derived glycolate, whereas mitochondria handle meat-derived hydroxyproline – both sources of glyoxylate production.

Thus, certain AGT genetic variations may affect a person’s response to their diet — and affect whether a plant- or meat-based diet works better. (This may also explain why researchers are still figuring out which dietary factors are most relevant: people may differ in their genetic risk and dietary response.)

Other genetic variations may directly influence oxalate absorption in the gut and sodium-phosphate transporters in the kidney.

Chronic diseases and health problems

There are various medical conditions that can lead to kidney stone formation. These conditions include:

• Bowel disease
• Medullary sponge kidney
• Hyperparathyroidism
• Milk-Alkali syndrome and ulcers – this increased in the early 1900s when folks tried to control ulcers with milk and antacids, leading to dangerous levels of calcium in the blood. This condition is on the rise again due to increased use of calcium and vitamin D supplements.
• Anatomic abnormalities with the kidney
• Paralysis
• Renal tubular acidosis
• Cystinuria
• Oxalosis

Medications used to treat kidney stones include:

• Alkaline potassium salts – used to raise urinary pH. You may need to dilute them with water if they cause stomach upset.
• Alkaline sodium salts – an alternative to potassium salts.
• Thiazides – diuretics used to decrease urinary calcium. You must control sodium intake when using them. They can deplete potassium levels in the body.
• Allopurinol – reduces production of uric acid in the body. Extremely serious side effects.

Summary and recommendations

We’ve made a lot of advances in our medical treatment of kidney stones. But ideally, you don’t ever want to have a kidney stone — or worse, have more than one.

Here are some ways to lower your risk.

Keep urine dilute

Drink at least 2 litres of water per day. Small amounts of coffee, tea, lemon water, and alcohol may also be helpful.

Get rid of the excess

If it doesn’t use stuff, our body has to excrete anything that we ingest. Overeating, overdrinking, and overmedicating can lead to more work for the kidneys. Big meals, yo-yo dieting, and binging put big demands on the kidneys and can promote stone formation. Avoid big meals before bed. (You’ll sleep better that way anyway.)

Vary fruit, vegetable, and nut/seed intake

If you rely on oxalate-rich foods year round, your kidneys might get overwhelmed. Eat a variety of foods, and eat with the seasons to give your kidneys a break. The food will be fresher, too. Bonus!

Limit animal protein

If you’re at risk, consider lowering your animal protein intake to no more than about 50 grams per day. Make up the rest from plant sources as much as possible.

Limit sodium intake

Less than 100 mmol/day (2300 mg/day). This is easy if you don’t eat processed foods.

Stay lean

Less body fat turnover means fewer waste products for the kidney to deal with.

Control calcium

No more than 800-1000 mg/day of calcium (food and supplements combined). With calcium, you don’t want to go too high or too low.

Use vitamin supplements with caution

Vitamins A and D can lead to increased calcium in the urine and stone formation. Only supplement with vitamin D if you require it (based on blood testing), watch out for fortified foods.

Vitamin C supplements can be excreted in the urine as oxalate. Avoid using them unless you’re deficient.

This includes fortified foods/drinks.

If you have stones, find a specialist

Watch out for internet scams.

Avoid antacids with calcium base

These can cause phosphate depletion and increase calcium in the urine.

Further resources

What I need to know about kidney stones

National Kidney Foundation

Extra credit

Ben Franklin suffered from kidney stones.

Adequate magnesium intake may help to prevent oxalate stone formation in the kidneys. Sources of magnesium apples, apricots, avocadoes, bananas, whole grains, nuts, and green leafy vegetables.

If you don’t care about kidney stones, you will after seeing a picture of a ureteroscopy!

Although kidney stones are generally higher in affluent regions, the highest incidence for kidney stones throughout the world is among uranium workers in eastern Tennessee and adults in northeast Thailand.

The protease inhibitor indinavir, used in HIV/AIDS, can increase risk for stones.

A high fat intake can increase oxalate absorption.

The ratio of calcium to oxalate in urine is usually 10:1.

Stones risk increases with a protein rich diet, but also from malnutrition.

There is currently no analysis or research that shows whether oxalic acid is present in hemp. Living Harvest is hoping to perform analysis by 2011.

NSAIDS and acetaminophen, used chronically, can damage the kidney, and increase odds of stone development.

With pregnancy comes changes in urinary pH, which can increase chances of stone development.

South Africans are virtually resistant to kidney stones, but standard urinary measurements haven’t been able to isolate why.

The drug Flomax might help to increase the likelihood of spontaneous stone passage (in someone with a passable stone).

References

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Dwyer JT. Health aspects of vegetarian diets. Am J Clin Nutr 1988;48(3 Suppl):712-738.

Patel AM & Goldfarb S. Got calcium? Welcome to the calcium-alkali syndrome. J Am Sco Nephrol 2010;21:1440-1443.

Rodman JS, Sosa RE, Seidman C, Jones R. No More Kidney Stones. 2007. John Wiley & Sons Inc.

Charrier MJ, Savage GP, Vanhanen L. Oxalate content and calcium binding capacity of tea and herbal teas. Asia Pac J Clin Nutr 2002;11:298-301.

Grases F, et al. Phytate acts as an inhibitor in formation of renal calculi. Front Biosci 2007;12:2580-2587.

Grases F, et al. Urinary phytate in calcium oxalate stone formers and health people—dietary effects on phytate excretion. Scand J Urol Nephrol 2000;34:162-164.

Zhou JR, Erdman JW Jr. Phytic acid in health and disease. Crit Rev Food Sci Nutr 1995;35:495-508.

Worcester EM & Coe FL. Calcium kidney stones. N Engl J Med 2010;363:954-963.

Golomb G. The Kidney Stones Handbook. 1994. Four Geez Press.

Shuster J, et al. Soft drink consumption and urinary stone recurrence: a randomized prevention trial. J Clin Epidemiol 1992;45:911–916.

Weiss GH, Sluss PM, Linke CA. Changes in urinary magnesium, citrate, and oxalate levels due to cola consumption. Urology 1992;39:331–333.

Rodgers A. Effect of cola consumption on urinary biochemical and physicochemical risk factors associated with calcium oxalate urolithiasis. Urol Res 1999;27:77–81.

National Kidney and Urologic Diseases Information Clearinghouse, National Institutes of Health. What I Need to Know about Kidney Stones. 2007. http://kidney.niddk.nih.gov/kudiseases/pubs/pdf/stones_ez.pdf

Jacobson K. Center for Science in the Public Interest. Liquid Candy. 2005. http://www.cspinet.org/new/pdf/liquid_candy_final_w_new_supplement.pdf

Schardt D. Skipping Stones: how to avoid kidney stones. Nutrition Action Healthletter. January/February 2009.

Taylor EN & Curhan GC. Body size and 24-hour urine composition. Am J Kidney Dis. 2006;48:905-915.

Sweeney DD, et al. Effect of carbohydrate-electrolyte sports beverages on urinary stone risk factors. J Urol 2009;182:992-997.

Stroller ML, et al. Changes in urinary stone risk factors in hypocitraturic calcium oxalate stone formers treated with dietary sodium supplementation. J Urol 2009;181:1140-1144.

Asplin JR. Obesity and urolithiasis. Adv Chronic Kidney Dis 2009;16:11-20.

Lewandowski S, et al. The influence of a high-oxalate/low-calcium diet on calcium oxalate renal stone risk factors in non-stone-forming black and white South African Subjects. BJU Int 2001;87:307-311.

Zilberman DE, Yong D, Albala DM. The impact of societal changes on patterns of urolithiasis. Curr Opin Urol 2010;20:148-153.

Porena M, et al. Prevention of stone disease. Urol Int 2007;79 Suppl 1:37-46.

Siener R, et al. The role of overweight and obesity in calcium oxalate stone formation. Obes Res 2004;12:106-113.

Massey LK & Kynast-Gales SA. Diets with either beef or plant proteins reduce risk of calcium oxalate precipitation in patients with a history of calcium kidney stones. J Am Diet Assoc 2001;101:326-331.

Borghi L, et al. Comparison of two diets for the prevention of recurrent stones in idiopathic hypercalciuria. N Engl J Med 2002;346:77-84.

Escott-Stump S. Nutrition and diagnosis related care. 2002. Lippincott Williams and Wilkins.

Nouvenne A, et al. Effects of a low-salt diet on idiopathic hypercalciuria in calcium-oxalate stone formers: a 3-mo randomized controlled trial. Am J Clin Nutr 2010;91:565-570.

Mahan LK & Escott-Stump S. Krause’s Food, Nutrition, & Diet Therapy. 2004. Saunders.

Parker JN & Parker PM. The official patient’s sourcebook on kidney stones. 2004. ICON Group International.

Pais VM, et al. Effect of dietary control of urinary uric acid excretion in calcium oxalate stone formers and non-stone-forming controls. J Endourol 2007;21:232-235.

Fink HA, et al. Diet, fluid, or supplements for secondary prevention of nephrolithiasis: A systematic review and meta-analysis of randomized trials. Eur Urol 2009;56:72-80.

Flagg LR. Dietary and holistic treatment of recurrent calcium oxalate kidney stones: review of literature to guide patient education. Urol Nurs 2007;27:113.

McKay DW, et al. Herbal tea: An alternative to regular tea for those who form calcium oxalate stones. J Am Diet Assoc 1995;95:360-361.

Childs D. Global warming may up kidney stone risk: study. ABC News. July 15^th 2008. http://abcnews.go.com/Health/story?id=5374174&page=1

Kenny JS & Goldfarb DS. Update on the pathophysiology and management of uric acid renal stones. Curr Rheumatol Rep 2010;12:125-129.

Grases F, et al. Renal lithiasis and nutrition. Nutrition J 2006;5:23-30.

Johri N, et al. An update and practical guide to renal stone management. Nephron Clin Pract 2010;116:c159-c171.

Hall PM, Nephrolithiasis: Treatment, causes, and prevention. Clev Clin J Med 2009;76:583-592.

Romero V, et al. Kidney stones: A global picture of prevalence, indcidence, and associated risk factors. Rev Urol 2010;12:e86-e96.

Passman CM, et al. Effect of soda consumption on urinary stone risk parameters. J Endourol 2009;23:347-350.

Choi HK, et al. Purine-rich foods, dairy and protein intake, and the risk of gout in men. NEJM 2004;350:1093-1103.

Choi HK, Liu S, Curhan G. Intake of purine-rich foods, protein, and dairy products and relationship to serum levels of uric acid: the Third National Health and Nutrition Examination Survey. Arthritis Rheum 2005;52:283-289.

Schlesinger N. Dietary factors and hyperuricaemia. Curr Pharm Des 2005;11:4133-4138.

Ince BA, Anderson EJ, Neer RM. Lowering dietary protein to U.S. recommended dietary allowance levels reduces urinary calcium excretion and bone resorption in young women. J Clin Endocrinol Metab 2004;89:3801-3807.

Nguyen QV, et al. Sensitivity to meat protein intake and hyperoxaluria in idiopathic calcium stone formers. Kidney Int 2001;59:2273-2281.

Knight J, et al. Increased protein intake on controlled oxalate diets does not increase urinary oxalate excretion. Urol Res 2009;37:63-68.

Giannini S, et al. Acute effects of moderate dietary protein restriction in patients with idiopathic hypercalciuria and calcium nephrolithiasis. Am J Clin Nutr 1999;69:267-271.

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Menopause is when the ovaries stop releasing eggs and menstruation ends for good. A woman has officially entered menopause on the 365^th day from the date of her last menstrual period.

However, women’s transition to menopause is usually gradual and involves fluctuating hormone levels and a range of symptoms for several years.

Female hormone “operation shut down” actually begins during the late twenties, but isn’t really evident until between the ages of 35 to 45 years. This is when many women start to notice changes in their bodies, minds, and feelings. Periods become irregular, the libido tanks, and counting sheep no longer helps with sleep. And hey, did someone turn up the thermostat?

A shared yet diverse experience

While there are common symptoms that many women experience (see below), and an official definition (see above), it’s important to understand that each woman’s experience of menopause is unique.

Symptoms of menopause, perceptions of menopause, and age of onset vary widely from woman to woman, region to region and by ethnicity. This is probably due to differences in

• lifestyle
• diet
• genetic factors
• reproductive history and pregnancy (for instance, on average African women have more children and hit menopause earlier than their counterparts of African descent living in the U.S., which researchers think may be due to demographic patterns of earlier and more frequent pregnancies)
• cultural factors: each culture and social group views menopause differently, which affects how women think about their own symptoms and experiences
• social factors: women have other life challenges, changes, and demands during midlife

In the U.S., about 85% of women will have entered menopause by age 52. With the population of older folks increasing in developed countries, more women are menopausal and post-menopausal.

When is too soon?

Since there’s no specific age of onset, and women’s experiences are diverse, it’s hard to define exactly what “premature” menopause is. However, if women have low sex hormone levels and their periods check out before age 40, that’s officially considered “premature”.

We don’t yet know why premature menopause occurs; it could have an autoimmune component and has been linked to other autoimmune disorders such as thyroiditis and fibromyalgia. Chances of premature menopause also go up with smoking, ovary damage (e.g. from surgery), genetic predisposition, and exposure to xenoestrogens.

What you should know about menopause

Ovaries produce estrogen, progesterone and androgens. They are signaled to do so by FSH (follicle stimulating hormone) and LH (luteinizing hormone) from the brain. With menopause, these hormones gradually decrease.

Changes in estrogen and progesterone during the life cycle

With advancing age, muscle mass and bone mass can decrease, which can influence other hormones in the body, leading to a decrease in GH, IGF-1, and DHEA.

As hormone levels change, so does the body. A perimenopausal woman should be on the lookout for:

• Loss of the menstrual cycle
• Hot flashes and night sweats
• Cardiovascular disease
• Osteoporosis
• Emotional changes
• Vaginal dryness/infections
• Incontinence/urinary tract infections
• Decline in sex drive
• Insomnia

Hormone production

As ovarian hormone production declines, sex hormones secreted by body fat and other organs such as the adrenal glands become more prevalent. The balance tips.

It’s important to keep your body fat in a healthy range with good nutrition and regular activity as you age. Having a lot of excess body fat puts your hormone production out of whack and creates systemic inflammation. That just makes things worse.

See All About Estrogens for more.

Hormone replacement therapy: A controversial option

Hormone replacement therapy (HRT) can offset low hormone levels in the body. Large studies have been completed that provide useful information about perimenopausal HRT, including the HERS study, the ERA study, and the Women’s Health Initiative Clinical Trial.

The Women’s Health Initiative Clinical Trial indicated that for women who are within 10 years of menopause who have taken HRT for 5 or more years, there is a 30% reduction in all cause mortality.

There are natural and synthetic options for HRT.

Natural hormones are substances identical to those produced in the body. Synthetic hormones are chemically altered so that companies can patent them, but still similar enough to the natural kind so they enter the cell and perform most of the same functions.

Only natural progesterone seems to help prevent cancers, normalize blood fats, restore sex drive and regulate sleep. Synthetic progestins can contribute to mood swings, fatigue, insomnia, bloating, weight gain, and anxiety.

Most published data on HRT relates to synthetic hormones, and many women’s health advocates have pointed out significant problems with using synthetic hormones, which are typically derived from non-human sources such as pregnant mares and not identical to the hormones already present in women’s bodies.

Based on available data, here’s how HRT — again, mostly with synthetic hormones — stands.

The American Association of Clinical Endocrinologists announced in 2008 that the benefits of HRT in women under 60 years of age outweigh the risks, and the use of HRT is supported by the ACOG and North American Menopause Society.

Note: Many of the negative HRT effects seem to occur when using combination therapy (synthetic estrogen + synthetic progestin) vs. estrogen only.

(Haas J, et al. Changes in the use of postmenopausal hormone therapy after the publication of clinical trial results. Ann Intern Med. 2004; 140:184-188.)

Why menopause is important

Most of the factors that accompany menopause are temporary, but some can be very harmful. Let’s highlight the biggies.

• Hot flashes/night sweats
• Cardiovascular disease
• Osteoporosis; decreased bone density
• Emotional changes
• Insomnia

“Power surge”: Hot flashes

Hot flashes aren’t really “harmful,” assuming they don’t harm your social life or light the bedsheets on fire. But they sure are a drag.

Some women never have hot flashes at all, probably because they are good at making estrogen from other sources like body fat and androgens.

Hot flashes usually last a few — seemingly interminable — minutes. During this time, skin temperature can actually increase by up to 8 degrees F. Core body temperature stays the same or decreases. Many women find that hot flashes are particularly bad at night.

Hot flashes often increase before menopause, peak 2-3 years after onset, and then taper off. Triggers include stress, coffee, spicy foods, alcohol, sugar, citrus fruits, high BMI, smoking, SSRIs, large meals, and intense exercise.

Soy and hot flashes

Just 25% of Japanese women experience hot flashes vs. 85% of North American women (although some researchers propose that these numbers might be skewed due to reporting bias).

Although there are probably many factors involved, such as genetics and other dietary factors such as fish/seafood consumption (which creates a higher level of omega-3 fatty acids), some think this variation is due to the consumption of soy.

Soy (and many other plant foods) contains isoflavones, a type of phytoestrogen, which are plant derived compounds that can exhibit hormonal activity. American women consume less than 3 mg of isoflavones per day, while women in Eastern Asia consume between 20 and 80 mg/day.

Consuming 50-100 mg/day of isoflavones from food seems to be a safe amount that helps to relieve hot flashes. This would be equivalent to consuming one of the following:

• 1 to 1½ cups soy milk
• 4-5 oz tempeh
• 4-5 oz tofu
• ½ cup edamame
• 3-4 tbsp miso
• ¼-1/2 cup soy nuts

However, flax meal may also be useful. One study showed that women suffering at least 14 hot flashes per week who added 4 tablespoons of flax meal per day to their diet for 6 weeks decreased daily hot flash frequency by 50%, and intensity dropped by 57%.

Some important notes:

Not all women efficiently convert phytoestrogens into a form the body can use to relieve menopausal symptoms.

Soy, like any food, can provoke hypersensitivity reactions. Some nutrition researchers note that soy can be allergenic or interfere with proper nutrient absorption and digestion.

If you are prone to thyroid and/or breast problems, as well as food intolerances, you might want to discuss eating more soy with a doc or dietitian first.

It’s best to get isoflavones from food rather than supplements. Isoflavone supplements might interfere with thyroid function and inhibit mineral absorption, so stick with whole food sources. Avoid consuming more than 150 mg of isoflavones per day.

Regular intake for 1-2 months is usually necessary to notice any effects from isoflavones.

Go with organic soy when possible.

The ACOG approves soy for relieving hot flashes.

Other options for hot flashes

Other options that might help to relieve hot flashes include:

• St. John’s wort (take caution as this herb interacts with various pharmaceuticals)
• yoga
• acupuncture
• massage
• meditation
• exercise

HRT is currently the only FDA approved treatment for hot flashes.

Options that don’t seem to help relieve hot flashes (and may cause additional problems) include:

• kava kava
• Dong quai
• evening primrose oil
• red clover
• ginseng
• black cohosh (Some cases of animal cancers have been reported, and there are 30 reports of serious liver damage with supplementation Mahady GB, et al. United States Pharmacopeia review of black cohosh case reports of hepatotoxicity. Menopause 2008;15(4 Pt. 1):628-638)
• wild yam cream (This contains progesterone precursors; yet humans lack the enzyme necessary to metabolize them. The only way to get true progesterone cream is with a prescription. OTC creams are fraudulent.)

Some menopause specialists simply recommend that rather than trying to eliminate hot flashes entirely, women integrate hot flashes into their daily lives: dress in layers, pop out for some fresh cool air if possible, etc.

Cardiovascular disease

Cardiovascular disease is the leading cause of death in postmenopausal women. Along with declining estradiol, as women age and put on body fat, they can develop insulin resistance/metabolic syndrome, which leads to Type 2 diabetes and further elevates their CVD risk.

While naturally occurring estradiol is cardioprotective, synthetic estrogen in HRT can lead to inflammation, blood clots, and be of no help to existing plaque on vessel walls.

To greatly decrease chances of developing heart disease as you enter menopause, do the following:

• Keep blood pressure below 120/80 mmHg
• Keep total cholesterol below 200 mg/dl
• Keep LDL below 70 mg/dl
• Keep HDL above 60 mg/dl
• Don’t smoke
• Manage stress and meditate
• Keep your body fat in a healthy range; don’t yo-yo diet
• Exercise at least 5 hours each week
• Consume plenty of whole, plant foods like vegetables, fruits, beans, whole grains, nuts and seeds
• Avoid processed foods and added sugar
• Include smaller amounts of alcohol, meat, fish, dairy, and eggs
• Drink tea and water

Osteoporosis

At menopause, calcium absorption is generally 50% below the adolescent peak rate. This is likely due to a lack of vitamin D (less time in sun, less consumed in diet, less uptake in gut).

Estrogen helps to slow bone breakdown and prevent factures by turning on vitamin D receptors in the gut (see more here: All About Vitamin D). HRT won’t help to build or replace bone, but it may help to prevent bone loss.

Ways to preserve bone mass upon menopause:

• Incorporate green leafy veggies, legumes and nuts/seeds – these seem to be the optimal sources of bone building calcium
• Get adequate sunlight to attain vitamin D (see more here: All About Vitamin D) — and hey, fresh air and exercise help relieve hot flashes too! Win-win!
• Avoid excessive alcohol, salt, carbonated drinks, and caffeine
• Check your calcium supplementation – it might contribute to the progression of cardiovascular disease. It’s best to only supplement when you can’t get enough calcium from food and vitamin D status is adequate. In addition, many women eating standard Western diets are actually deficient in magnesium and other trace minerals (such as phosphorus), not calcium.
• Eat soy – soy can increase intestinal calcium absorption and protect bone cells
• Do weight bearing exercise (resistance training, walking, etc.)
• Don’t smoke
• Include foods from the allium family – these can protect bones and inhibit cancer development
• Avoid refined sugars/grains – these don’t provide nutrients, can diminish bone health, increase inflammation, and result in mood swings and fatigue

Recent research suggests that osteoporosis is less a disease of “not enough calcium” and more about systemic inflammation and poor mineral absorption, particularly from a diet high in grains and dairy and low in veggies. (See All About Dietary Acids and Bases). There is evidence that estrogen may affect inflammatory cytokines (cell signaling molecules).

Emotional changes

Many women notice emotional highs and lows. This is a scientifically detached and polite way of saying that many women sometimes feel like they’re going nuts.

Emotional symptoms can include:

• crying spells; sadness
• irritability and anger
• panic and anxiety; sense of dread or impending doom
• depression and lethargy

To ensure a stable mood:

• Incorporate plenty of whole foods rich in vitamin C like bell peppers, citrus fruits, broccoli, teas, potatoes, and yams
• Eat foods with B vitamins for the nervous system like wild rice, brown rice, quinoa, buckwheat, polenta, and green leafy vegetables
• Get outdoors for recreation
• Eat whole grains to bump up serotonin
• Eat regular meals
• Limit processed foods, added sugars, alcohol and caffeine
• Incorporate omega-3 fats from algae, flax, hemp, chia, and walnuts
• Address underlying factors, e.g. stress, relationship difficulties, etc.

Many women find that counselling is helpful during this period. Midlife is also a period of life change, and mood changes can reflect “real” changes, shifts in priorities or life demands, and/or underlying issues (such as changes in family dynamics or caregiving).

Recognize that these symptoms are common, and (in part) related to hormonal changes — you’re not going crazy!

Insomnia

This is often due to night sweats and/or anxiety, but generalized hormone fluctuations can cause sleep disturbances too. Along with changes in sex hormones, women may notice changes in other hormones such as thyroid and/or adrenal hormones.

To promote restful sleep:

• Limit alcohol (see here for more on this: All About Alcohol) – remember that alcohol can compromise liver function, diminishing its ability to metabolize estrogens
• Limit caffeine
• Try a small serving of starchy carbohydrates in the evening, which can increase serotonin
• Avoid protein, sugar, fat, beans, and liquids before sleeping
• Melatonin or valerian might help with sleep, but side effects can occur
• Basic sleep hygiene is in order; see All About Sleep for more
• Other hormonal conditions can affect sleep, so discuss any symptoms with your doctor or endocrinologist

There are social factors too. Many midlife women are struggling with competing responsibilities: paid work, unpaid work (e.g. domestic work), caregiving for children and aging parents, etc. It’s no wonder that many of them can’t sleep!

Other physical and mental changes

Hey, where did that spare tire come from? Why are you feeling more like an apple than a pear these days? Why doesn’t food X agree with you any more? Why is it so hard to lose fat? Why are you suddenly attracted to elastic waistbands? And where did you leave your freaking car keys??!

There are many other physical and mental changes that can occur in midlife, which again reflect changes in both the physical environment (i.e. hormonal changes) and changes in your personal life (e.g. caregiving stress). This includes:

• changes in sex drive
• vaginal dryness; yeast infections; bladder infections and interstitial cystitis
• changes in breast size (as estrogen declines) and comfort (e.g. tenderness, lumpiness)
• forgetfulness; “brain fog”; difficulty concentrating
• digestive changes; new food intolerances
• water retention; bloating
• increased intensity of PMS symptoms
• difficulty losing fat
• changes in appetite and/or food cravings
• dizziness; lightheadedness
• heart palpitations
• “inner tremor” or jitteriness; some women talk about it feeling like an “inside earthquake”
• headaches; migraines
• joint pain
• tingling, “electric shock” type pain in extremities
• fatigue; lethargy
• hair loss; thinning hair
• brittle nails

Summary and recommendations

Physical, intellectual, and emotional changes in midlife are normal for men and women. Changes take a variety of forms.

Each woman’s experience of menopause is unique. You can significantly affect your menopause symptoms with good nutrition and regular activity.

Symptoms are complex and inter-related. For instance, changes in digestion or the hormonal environment can affect fat loss. Insomnia can add to your stress, worsen your mood, and make you want to reach for that caffeine.

Build a strong support network that includes health care providers, coaches, counsellors, other women, family and friends, etc. Ask for help. Don’t go it alone.

Do your homework and learn about your experiences, as well as those of other women. Chances are, you’re not “abnormal”.

If menopausal symptoms are manageable, exploring natural options is likely the best option. For those with significant and debilitating menopausal symptoms, and under the age of 60, HRT might be something to consider.

Living, exercising, and eating the PN-style way can help control symptoms and decrease chances of potential diseases associated with menopause. This includes:

• Keep your body fat in a healthy range; don’t yo-yo diet
• Exercise at least 5 hours each week, and include weight-bearing activities as well as stress-relieving activities such as outdoor walking
• Consume plenty of whole, plant foods like vegetables, fruits, beans, whole grains, nuts and seeds
• Include controlled amounts of alcohol, caffeine, meat, fish, dairy, and eggs
• Avoid processed foods, added salt, smoking, and added sugar
• Drink tea and water
• Consider eating small amounts of whole soy foods each day
• Manage stress and meditate

Extra credit

A hysterectomy will cause menstrual periods to stop, but it won’t induce menopause, because the ovaries continue to function.

Bloating with menopause/post-menopause can be due to changes in digestive abilities. Stomach acid tends to decrease. This can be alleviated with a digestive enzyme supplement, digestion tea with peppermint/ginger, limiting animal foods, using a probiotic rich food or supplement, and lightly cooking raw vegetables.

Taking a contraceptive pharmaceutical can mask perimenopuase by controlling typical symptoms. This doesn’t “change” the time of menopause for you.

Estradiol tends to suppress appetite.

The Japanese have no word for “hot flash.”

A plant-based diet is associated with fewer hot flashes.

Changes in estrogen might influence fat cell activity in the abdomen.

Men can experience hot flashes when testosterone suddenly drops, such as in prostate cancer treatment.

Current data provides assurance that isoflavone exposure at levels consistent with historical Asian soy intake doesn’t seem to result in adverse effects on breast tissue.

Cruciferous vegetables may guard against estrogen dependent cancers.

Seaweed has minerals for thyroid function and can inhibit cancer development.

Further resources

North American Menopause Society

The American Congress of Obstetricians and Gynecologists

References

Avis, Nancy, et al. Is there a menopausal syndrome? Menopausal status and symptoms across racial/ethnic groups.
Social Science and Medicine (February 2001), 52 (3), pg. 345-356.

Pinkerton JV, Stovall DW, Kightlinger RS. Advances in the treatment of menopausal symptoms. Womens Health 2009;5:361-384.

Maltais ML, Desroches J, Dionne IJ. Changes in muscle mass and strength after menopause. J Musculoskelet Neuronal Interact 2009;9:186-197.

Taylor N. Natural Menopause Remedies. New American Library. New York, NY. 2009.

Herrington DM, et al. Effects of estrogen replacement on the progression of coronary-artery atherosclerosis. N Engl J Med 2000;343:522-529.

Lakoski SG, et al. Hormone therapy, C-reactive protein, and progression of atherosclerosis: data from the Estrogen Replacement on Progression of Coronary Artery Atherosclerosis (ERA) trial. Am Heart J 2005;150:907-911.

Abdali K, et al. Effect of St. John’s wort on severity, frequency, and duration of hot flashes in premenopausal, perimenopausal and postmenopausal women: a randomized, double-blind, placebo-controlled study. Menopause 2010;17:326-331.

Bolland MJ, et al. Effect of calcium supplements on risk of myocardial infarction and cardiovascular events: meta-analysis. BMJ 2010;341:c3691.

Mundy, Gregory. Osteoporosis and inflammation. Nutrition Reviews 65 no.12 (December 2007): S147–S151.

Crawford AM. The Natural Menopause Handbook. Crossing Press. Berkeley, CA. 2009.

Glenville M. Healthy eating during menopause. National Book Network. Lanham, MD. 2004.

Cheung T. The all-natural menopause diet. Pegasus Books. New York, NY. 2008.

Thacker HL. The Cleveland Clinic Guide To Menopause. Kaplan Publishing. New York, NY. 2009.

Seaman B & Eldridge L. The no-nonsense guide to menopause. Simon & Schuster. New York, NY. 2008.

Messina MJ & Wood CE. Soy isoflavones, estrogen therapy, and breast cancer risk: analysis and commentary. Nutr J 2008;7:17-29.

Edelman JS. Menopause Matters. The Johns Hopkins University Press. Baltimore, MD. 2010.

Saxena T, et al. Menopausal Hormone Therapy and Subsequent Risk of Specific Invasive Breast Cancer Subtypes in the California Teachers Study. Cancer Epidemiol Biomarkers Prev. 2010;Online First.

Cassidy A. Diet and menopausal health. Nursing Standard. 2005;19:44-52.

Pines A & Berry EM. Exercise in the menopause – an update. Climacteric 2007;10(Suppl2):42-46.

Kronenberg, F. Menopausal hot flashes: A review of physiology and biosociocultural perspective on methods of assessment. J Nutr 2010;140:1380S-1385S.

Messina M. A brief historical overview of the past two decades of soy and isoflavone research. J Nutr 2010;140:1350S-1354S.

Hagey AR & Warren MP. Role of exercise and nutrition in menopause. Clin Obstet Gynecol 2008;51:627-641.

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But where did that colour come from? And are we all going to regret slurping up that milk?

What are food colour additives?

A food additive is defined as:

Any substance not normally consumed as a food in itself and not normally used as a characteristic ingredient of food, whether or not it has nutritive value.

Thanks for nothing, definition. So basically, a food additive is something that doesn’t normally occur in the food we eat — it has to be added… hence the name.

There are many types of food additives: preservatives, sweeteners, firming agents, anti-caking agents, etc. (For a full list of food additives see the FDA site or Health Canada, which has a handy Food Additive Pocket Dictionary — great for when you can’t remember the difference between isopropyl alcohol and isobutane.)

Colour additives are categorized as either dyes or lakes.

Dyes dissolve in water and are manufactured as powders, granules, liquids or other special-purpose forms. They can be used in beverages, dry mixes, baked goods, dairy products, jams, pudding, pie filling, yogurt, popsicles, pet foods and a variety of other products.

Lakes are the water-insoluble form of the dye. Lakes are more stable than dyes and are ideal for colouring products containing fats and oils, or items without enough moisture to dissolve dyes. Typical uses include coated tablets, cake and donut mixes, cheese, margarine, candy and chewing gums.

Where do food colours come from?

Humans have long known that certain plants, animals, and minerals will stain surfaces such as fabric, skin, wood, and food. Naturally occurring pigments in these plants and minerals — or the chemical reactions that can occur (e.g. when things go green with the oxidization of copper) — create the colours. This includes things like:

All of these, by the way, are legal “natural” food dyes.

With the advent of industrial processing, many food dyes were originally synthesized from coal tar, a carcinogen. Now they tend to be petroleum (oil) based.

Types of food color additives

In the United States, the Food and Drug Administration divides food colour additives into two groups: certified, and exempt from certification.

Certified colours are synthetically produced (or human made) and used widely because they impart an intense, uniform color, are less expensive, and blend more easily to create a variety of hues. Only 9 are permitted in the U.S. (More on this below.)

Colors that are exempt from certification include pigments derived from “natural” sources such as vegetables and animals as well as metals/minerals such as aluminum, silver, iron, and titanium dioxide. These are usually more expensive, and may add unwanted or unintended flavours to foods.

Why do manufacturers use food colour additives?

Manufacturers use colour additives to cover up an absence of natural colour (e.g. in margarine), offset colour loss due to light/air/temperature exposure, and give the product “added value.”

See the food colour additives on the ingredient panel of Froot Loops? What colour do you think Froot Loops were before all those chemicals were added? (Hint: See All About Breakfast Cereals.)

What you should know about food colour additives

The most widely used dyes areR ed 40, Yellow 5, and Yellow 6 – accounting for 90% of all dyes used. They contain carcinogens and may cause allergic reactions. Each year, about 15 million pounds of synthetic dyes go into the U.S. food supply (well, the “processed” U.S. food supply).

Since 1955 our consumption of food colour additives has increased by five times. Translation: the U.S. eats a lot of processed foods.

What are the problems with food colour additives?

There are some potential problems with food dyes, specifically:

• Carcinogenicity – leading to cancer development
• Genotoxicity – leading to mutations or damaging chromosomes
• Neurotoxicity – leading to the damage of nerve tissue

Banned food dyes include:

• Green 1, Red 1 – promote liver cancer
• Orange 1, Orange 2, Violet 1, Red 2, Red 32 – carcinogenic
• Sudan 1 – toxic
• Yellow 1 and 2 – lead to intestinal lesions
• Yellow 3 and 4 – promote heart damage

While some studies show that certain dyes aren’t themselves strong carcinogens, there may be a synergistic effect. Thus, various food dyes in a single processed food could lead to more potent carcinogenicity.

Ummm... should I eat that? Is that food?

There are still nine food dyes permitted by the FDA. According to the FDA, these nine dyes don’t have enough evidence to warrant a ban.

FD&C Blue Nos. 1 and 2 – I remember hearing stories from the nurses at the hospital where I worked, about using Blue no. 1 in feeding tube solutions. They did this with the intent to trace the flow of liquid into the gut and not the airway (because a feeding tube entering the lungs can lead to pneumonia).

Animal studies indicate that small amounts of Blue no. 1 are absorbed through the GI tract. That’s not good. And what’s really not good is that the animals in those studies were “healthy,” not confined to the ICU. People getting tube feeds in the ICU tend to have weak GI tracts. Beginning in 1999 a series of reports appeared that indicated Blue no. 1 could pass across the digestive tract and into the blood, often with catastrophic penalty. In 2003 the FDA advised against putting this dye in feeding tubes.

But it’s still in food.

To get this...

...manufacturers use this.

FD&C Green No. 3 – may promote cancer in animals and isn’t used very often in the North American food supply.

FD&C Red Nos. 3 and 40 – Red 40 is one of the most common food dyes (check out Orange Crush) and might promote tumours in animals. Red no. 3 has been around since 1907. You know those maraschino cherries in your Shirley Temple? Those have been coloured with red no. 3. Red no. 3 is an animal carcinogen and is genotoxic.

FD&C Yellow Nos. 5 (tartrazine) and 6 – these dyes have connections to hypersensitivity reactions. The chemical structure is very similar to benzoate and salicylate (the active ingredient in aspirin). Yellow no. 5 seems to be mutagenic (aka mutation-causing; DNA-damaging) in animals and might also have random contaminants. Yellow no. 6 might also include contaminants, but doesn’t appear to promote cancer.

Orange B – not much to say about this except I would like to have this name if I were a rapper. Actually, orange B is only permitted for use in sausage casings. Animal studies show potential problems with the spleen, lymphatic system and kidneys when exposed to orange B. The FDA wanted to ban this in 1978, but never followed through because most food companies stopped using it.

Citrus Red No. 2 – often added to orange peels. Enough of this stuff is produced each year to colour 2 billion oranges. It seems to promote cancer and tumors in animals.

Note: FD&C stands for Food, Drug and Cosmetic

So, “natural” is OK, right?

Well, that depends. Some “natural” food additives are likely just fine.

• In the case of dehydrated beets, for instance, it’s probably not a big deal.
• With beta-carotene, the worst that’ll probably happen is you turning orange from over-consumption.
• Turmeric comes from the ginger family of plants, and may have anti-inflammatory properties, although there’s probably not enough of it in your yellow mustard to make that mustard a health food.

Other “natural” food additives might be more problematic. For example:

• Annatto extract – a carotenoid extracted from a tropical tree seed (Bixa orellana), often added to cheese. Has been implicated in IgE mediated allergic reactions.
• Cochineal extract or carmine is a red dye made from crushed cochineal beetle. It’s now listed on the ingredient label as cochineal extract or carmine (before 2009 it didn’t need to be). 70,000 beetles may be killed to produce one pound of this red dye. Has been implicated in IgE mediated allergies.
• Caramel colour – this makes cola brown and beer gold. Caramel colour is the most commonly consumed food colouring ingredient in the world. It’s produced by heating carbohydrates (like fructose, dextrose, or invert sugar) with a food-grade acid (like sulfuric, phosphoric, or citric) to break the sugar bonds. Think of caramel colour as burnt sugar. Negative health consequences of caramel colour are unlikely as long as someone doesn’t consume loads of it. (For more on the problems with the Maillard reaction, see All About Cooking & Carcinogens.)  There is the potential of an allergic reaction.
• Titanium dioxide, which makes things white (such as your soymilk), has recently been classified by the International Agency for Research on Cancer (IARC) as an IARC Group 2B carcinogen — ”possibly carcinogenic to humans”.
• Aluminum, used as an additive in a variety of foods such as cake decorating materials, canned seafood (including caviar), and relish, might cause adverse effects related to reproduction, neurological behaviour and neurological development.

How are additives regulated?

In 1938, after people raised concerns about dyes in food and beauty products, the US passed the Food, Drug and Cosmetic Act. In 1960, the Color Additives Amendment was enacted, which ruled that the FDA had to approve any new food colour additive before any food colour additive could hit the market.

Relative to other industrialized regions, the U.S. tends to have weaker food regulations.

In the European Union (EU), the Community legislation on food additives is based on the principle that manufacturers can use only those additives that are explicitly permitted. Food additives in the EU may only be permitted if:

• there is a technological need for their use,
• they do not mislead the consumer,
• they present no hazard to the health of the consumer.

Most food additives may only be used in limited quantities in certain foodstuffs. If regulations don’t specify a particular upper limit for a particular additive, that additive must be used according to good manufacturing practice — only as much as necessary to achieve the desired technological effect.

In Canada, food colour additives are regulated by Health Canada, which is currently considering legislation that will require manufacturers to list which colours they use… instead of just saying “colour”.

Why are food colour additives important?

If you eat processed food, you likely eat food colour additives. Many experts have raised health concerns about food colour additives.

Food additives and children

The European Union (EU) requires that food colour additives must have a warning label when added to food, since they may cause adverse effects on activity and attention in children. You’ll currently find the following warning on the label:

“May have an adverse effect on activity and attention in children”

In the U.K., almost 30% of kids under 11 years old have experienced problems with consuming food additives. Still, food colour additives don’t seem to provoke as many complications as other additives (e.g., aspartame, monosodium glutamate, etc.).

Researchers have speculated on behavioural problems related to food colouring ingestion since the 1970s. A 2004 meta-analysis concluded that artificial dyes influence children’s behaviour, and two studies funded by the British government found that mixtures of dyes (along with the preservative sodium benzoate) unfavorably influence the behaviour of kids.

In the U.K. the same food products we have in the U.S. are coloured with different additives.

In the U.S.	In the U.K.
Fanta orange soda is dyed with Red 40 and Yellow 6	Fanta orange soda is dyed with pumpkin and carrot extract
In the U.S.	In the U.K.
Kellogg’s Strawberry Nutrigrain bars are coloured with Red 40, Yellow 6 and Blue 1	Kellogg’s Strawberry NutriGrain bars are coloured with beetroot, annatto and paprika extract
In the U.S.	In the U.K.
McDonald’s Strawberry Sundaes are coloured with Red dye 40	McDonald’s Strawberry Sundaes are coloured with strawberries

Side rant: Before you get ready to throw down at the FDA offices, consider what foods we are talking about here. Orange soda, cereal bars, and strawberry sundaes? I don’t care if those are coloured with rare flower petals from Fiji – if you consume them on a regular basis, your health is probably going to suffer.

Candy indicating “no artificial dyes or flavours” – could still give you cavities and diabetes

Most unfavourable responses to food colour additives do not involve the production of IgE antibodies, except if there is an allergy to a food colouring derived from a plant/animal source (e.g., annatto extract, cochineal extract, etc.).

PDF Summary of food dye studies (source: Center for Science in the Public Interest)

Summary and recommendations

While a few food colour additives may not show direct evidence of causing health problems, many do. Further, food colour additives are unlikely to promote health and longevity (but hey, you never know). So – why bother consuming them at all?

The easiest way to avoid food colour additives is to eat whole, unprocessed foods (except for that orange peel colouring, as well as substances like beta-carotene in chicken feed to make anemic yolks brighter yellow). If possible, buy from small farmers and ask about how they treat their foods and animals.

If you buy a processed food, check the ingredients. When you check the ingredients, if you see any of the following words, set it down and back away slowly:

• Artificial colour
• Green, orange, red, violet, blue, or yellow followed by a number
• Caramel colour

Extra credit

One study in rats indicated that blue food dye could actually prevent paralysis after spinal cord injury (see here: CBS News Story).

Further resources

Summary of colour additives for use in the U.S. in foods, drugs, cosmetics, and medical devices

References

Lucarelli MR, et al. Toxicity of food and drug cosmetic blue number 1 dye in critically ill patients. Chest 2004;125:793-795.

U.S. Food and Drug Administration. FD & C Blue no. 1 in enteral feeding solutions. Public Health Advisory. Sept 29 2003.

McCann D, et al. Food additives and hyperactive behavior in 3-year-old and 8/9-year-old children in the community: a randomized, double-blinded, placebo-controlled trial. Lancet. 2007;370:1560-1567.

European Commission. Food Safety: Food Additives (contains links to relevant legislation).

Curran L. EU places warning labels on foods containing dyes. July 21, 2010. http://www.foodsafetynews.com/2010/07/eu-places-warning-labels-on-foods-containing-dyes/

Kobylewski S & Jacobsen MF. Food dyes: a rainbow of risks. June 2010. Center for Science in the Public Interest. http://cspinet.org/new/pdf/food-dyes-rainbow-of-risks.pdf

Artificial food colouring and hyperactivity symptoms in children. Prescrire Int. 2009;18:215.

Schab DW & Trinh NH. Do artificial food colours promote hyperactivity in children with hyperactive syndromes? A meta-analysis of double-blind placebo-controlled trials. J Dev Behav Pediatr. 2004;25:423-434.

Fuhrman J. Dangers associated with food dyes. July 16, 2010. http://www.diseaseproof.com/archives/food-safety-dangers-associated-with-food-dyes.html

CBS News. Does blue food dye prevent paralysis? July 28, 2009. http://www.cbsnews.com/stories/2009/07/28/earlyshow/health/main5193187.shtml

FDA: Food ingredients and colours. Revised April 2010. http://www.fda.gov/food/foodingredientspackaging/ucm094211.htm

Bateman B, et al. The effects of a double blind, placebo controlled, artificial food colourings and benzoate preservative challenge on hyperactivity in a general population sample of preschool children. Arch Dis Child 2004;89:506-511.

McCann D, et al. Food additives and hyperactive behavior in 3-year-old and 8/9-year-old children in the community: a randomized, double-blinded, placebo-controlled trial. Lancet 2007;370:1560-1567.

Randhawa S & Bahna SL. Hypersensitivity reactions to food additives. Curr Opin Allergy Clin Immunol 2009;9:278-283.

Skypala I. Other causes of food hypersensitivity. In: Food Hypersensitivity, eds: Isabel Skypala & Carina Venter. Wiley Blackwell. 2009.

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Blood is a transport system for the body. We carry all kinds of things in the approximately 5 litres of blood that circulates constantly through our system. Blood tests, aka blood work, can show us what’s in our blood — and by extension, what’s in our bodies. Blood can also show us changes in our bodies that we might not be able to see from the outside — such as our blood sugar levels or nutritional status.

Thus, we can use blood work to assess overall health, and it can give us a much more accurate and objective snapshot of wellness than “Gee, I think I had some veggies yesterday” or “I feel fat today”.

How is blood work done?

We get blood for testing from:

• Capillary skin puncture (finger stick)
• Dried blood samples
• Blood drawn from an artery
• Blood drawn from a vein (most common)
• Bone marrow aspiration

What happens to blood after it’s drawn?

Blood is analyzed in a lab. The blood is put into a centrifuge and spun until it separates.

Reference ranges

Then, technicians compare results to a “reference range.” The reference range is the range of expected values for each test listed.

Expected ranges used in lab analyses include 95% of the “healthy” population. So, 95% of healthy people would have lab values within these ranges. This range varies depending on the lab, region (e.g. US vs EU) and type of blood component.

A number above or below this reference range can give valuable diagnostic information about body systems. High and low values are especially useful when taken in context with other symptoms, lifestyle factors, and tests.

Variation in results and ranges

Lab values vary for each person and must be assessed relative to other factors. While reference ranges are established after testing a large number of healthy people, everyone is slightly different.

Blood analyses vary based on:

• Time of year
• Posture/positioning
• Food/fluid intake
• Stress
• Medication/supplement use
• Alcohol
• Smoking
• Exercise/physical activity
• General tests

Blood work: the tests

The basic test

A general lab ordered by a physician is typically called SMAC-20, SMA-20, or Chem-20.

This basic test looks at 20 different parts of the blood including levels of certain minerals, proteins, etc. This test is standard and should be done, although it’s not very telling of one’s overall health profile.

Beyond the basic SMAC-20, there are many different blood tests you can request. Highlighted below are some of the most useful tests.

Cardiovascular tests

Liver function tests

Kidney function tests

Thyroid tests

Reproductive function tests

Carbohydrate tolerance tests

Protein status tests

Vitamin, mineral, acid/base status tests

White blood cell tests

Red blood cell tests

Miscellaneous tests

Summary and recommendations

Getting annual blood work with a physician is a good idea for preventative health. You can observe trends and catch potential health problems before they spiral out of control. Make sure to request a copy of your lab results.

Extra credit

Most blood collection tubes contain EDTA as an anticoagulant. The same EDTA that’s in Fresca….

Mishaps with blood draws

• If blood is drawn from your arm after the tourniquet is on for several minutes, values can be skewed because cells will concentrate in the lower arm.
• If the needle used is too small, it can cause red blood cells to break, leading to a skewed analysis.
• If the puncture site isn’t sanitized – infection can result.
• If you tense up excessively during a blood draw, you can experience extensive bruising at the site.

Further resources

Amarillo Medical Specialists

Lab Tests Online

References

Medical Tests Sourcebook. Third Edition. Health Reference Series. 2008.

Fischbach F. A manual of laboratory and diagnostic tests. 7th Ed. Lippincott Williams and Wilkins. 2004.

Lab Tests Online.

Mahan & Escott-Stump. Krause’s Food, Nutrition, & Diet Therapy. 2004. Elsevier.

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• It can make food safer
• It can concentrate tastes and flavors
• It can reduce spoilage
• It can soften tough foods
• It increases the amount of energy our bodies can get from food
• It breaks starch molecules into more digestible fragments
• It denatures protein molecules

But before we get too excited about cooking, the modern diet can be overwhelmingly heat-processed. Higher cooking temperatures can create chemical reactions among amino acids, creatines, and sugars — reactions that may produce dangerous carcinogens and mutagens (compounds that can damage our DNA).

Now suddenly we have “unhealthy” compounds created in otherwise “healthy” foods — stuff like potatoes, fish, whole grains, etc.

Don’t freak out and throw your barbecue grill off the balcony just yet. Let’s start by learning more about what these compounds are, and how they work.

Cooking creates chemical compounds

Heat plus food molecules can create several products in the process of chemical conversion known as cooking. (And you thought you were just slapping a burger on the grill! Now you can say “I am chemically converting proteins!” Fancy.)

Some of the most notable end products include:

• Heterocyclic amines and polycyclic aromatic hydrocarbons
• Advanced glycation end products
• Acrylamide

Let’s look at each of these in more depth.

Heterocyclic amines (HCAs) and polycyclic aromatic hydrocarbons (PAHs)

What are they and where do they come from?

HCAs are made when creatines and amino acids (both found in meats) react together with heat. PAHs include over 100 different compounds formed by the incomplete burning of organic matter (e.g., oil, gas, coal, food, etc.) at temperatures in excess of 392 degrees F (200 C).

How heat from cooking forms HCA compounds

Thus, raw foods don’t have HCAs nor PAHs. Indeed, more than 90% of our exposure to HCAs and PAHs comes from cooked food.

The most concentrated sources include grilled/charred meats and fish. However, ready-to-eat commercial breakfast cereals, processed carbs, fats/oils, and tobacco smoke also contain high amounts of PAHs. PAHs in vegetables and fruits occur mostly due to environmental contamination of air and soil.

Four factors influence HCA formation:

• Type of food
• Cooking method
• Temperature
• Cooking duration

Temperature is the most important factor. Problems begin at 212 F (100 C), with the real nasty HCAs forming at about 572 degrees F (300 C).

PAH formation is influenced by:

• Temperature of cooking
• Duration of cooking
• Type of fuel used in heating
• Distance from heat source
• Fat content of the food

Essentially, the hotter and longer a meat is cooked, the more HCAs and PAHs. Direct heat methods like frying and grilling produce more than indirect-heat methods like stewing, steaming or poaching.

Studies estimating the intake of HCAs show an average 26 ng/kg body wt/day for a U.S. population.

Why should we worry about them?

HCAs are on the official list of cancer-causing agents published by the NIH. We’ve known about them since the 1970s — and they are straight up genotoxic, meaning that they work at the DNA level causing mutations, deletions, and insertions. Not good.

Thus far, we’ve identified 17 different HCAs that may increase cancer risk.

Along with heme iron and nitrates/nitrites, HCAs and PAHs may be the major reasons that “meat” is associated with cancer at all. Pickled, smoked, barbecued and processed meats (e.g., bacon, ham, sausage, hot dogs, salami, bologna, luncheon meats, corned beef, etc.) seem to cause the most health problems.

It’s the intake of these meats that are more related to cancer risk than total red meat intake alone. Other dense protein foods (milk, eggs, legumes, and organ meats) have very little or no HCA content naturally or when cooked.

What can we do about them?

We can start by changing our cooking methods. Opt for slower, indirect-heat methods of cooking such as poaching, stewing, braising, or steaming.

We can consume more plants in our diets. Plant-based diets typically contain insignificant amounts of HCAs and moderate amounts of PAHs. Those eating a higher raw plant-based diet tend to consume even lower amounts.

HCAs and PAHs can be removed from the body via detoxification in the liver. A plant-based diet can decrease the extent of DNA damage and oxidation from these compounds. Thus, not only do plants have fewer HCA/PAH-creating compounds, but they also help fight the effects of any of these compounds once created.

Source: Kapiszewska M. A vegetable to meat consumption ratio as a relevant factor determining cancer preventive diet. Local Mediterranean Food Plants and Nutraceuticals. Forum Nutr. 2006;59:130-153.

Experts recommend a ratio of greater than 2:1, plant foods:meats as the minimum recommended intake to support the body’s fight against cancer development. The protective effect seems to increase with ratios greater than this (3:1, etc.). The more plants, the less cancer.

Advanced glycation end products (AGEs)

What are they and where do they come from?

When you slap a burger on the grill and char it up good, pop a slice of bread into the toaster, or roast a marshmallow while camping, you’re creating the Maillard reaction, which occurs when sugars and proteins in the food react together with heat.

Sadly, while possibly increasing the scrumptiousness of these foods (which, by the way, also creates the characteristic flavours of caramel), this reaction can lower the nutritional value and create toxic/carcinogenic end products, including advanced glycation end products (AGEs), also known as glycotoxins.

Thanks, Maillard reaction!

Now take a look at the grill after cooking, or try to pry the sticky marshmallow off the campfire rock after it dropped from your roasting skewer. See how all those yummy brown roasty bits have glued themselves to the surface? That’s what happens in your body with AGEs. Stuff starts to stick together.

AGEs can be created inside our body with aging and high blood sugar. But we also eat AGEs. Virtually any food exposed to extreme heat can scorch, generating AGEs.

Adding dry heat to uncooked food can increase that food’s AGE content by 10 to 100 times. But AGEs can be produced during pasteurization, drying, smoking, frying, microwaving and grilling. Any food that contains sugars, fats, and proteins is fair game.

The standard American diet likely contains about 16,000±5,000 kU of AGEs each day. This is three times higher than the safety limit advised by professional organizations. Plant-based diets contain lower amounts, unless they are built upon processed and fried foods. Diets with more raw foods typically contain minimal AGEs.

Why should we worry about them?

Once in the body, AGEs have been shown to negatively affect a majority of cells, tissues, and organs (see diagram below). Fewer AGEs circulating in the system means a lower risk of diseases like Alzheimer’s, kidney, cardiovascular, and diabetes.

Source: Semba RD, et al. Does accumulation of advanced glycation end products contribute to the aging phenotype? J Gerontol A Biol Sci Med Sci 2010;May 17 Epub.

In animal models, AGEs contribute to:

• inflammation
• atherosclerosis
• kidney damage
• neurodegenerative disease
• muscle loss
• cancer cell metastasis
• insulin resistance
• alterations in cell receptors
• a shorter life
• oxidation

However, some suggest that rats/mice aren’t accustomed to the intake of heated food and might not be an accurate study model that translates to humans.

10% of dietary AGEs are absorbed. Of this 10%, about 1/3 are excreted in the urine within three days. This means they probably hang around the body wreaking havoc.

This will help you put it in perspective (click to enlarge):

Sources: Uribarri J, et al. Advanced glycation end products in foods and a practical guide to their reduction in the diet. J Am Diet Assoc 2010;110:911-916; Goldberg T. Advanced glycoxidation end products in commonly consumed foods. J Am Diet Assoc 2004;104:1287-1291.

What can we do about them?

Method of food preparation is critical here. Heating foods over 446 degrees F (230 C) seems to be the most problematic.

For example, the same 90 gram chicken breast can vary from 1000 to 9000 AGEs:

• Frying, grilling, roasting, or broiling: 4000 to 9000 AGEs
• Boiling, steaming, or stewing: 1000 AGEs

To immediately start consuming 50% less AGEs, poach, stew, or steam meals. This 50% reduction can decrease plasma levels of AGEs by 30% within a month.

Thus:

• Cook food at a lower temperature
• Don’t char it or cook the heck out of it
• Avoid processed foods, which have more AGEs — home prepared versions (such as French fries) have fewer AGEs compared to their processed counterparts
• Use liquid in cooking (for example, in braising)
• Use acids such as lemon juice or vinegar in marinades and cooking liquid — these will also help decrease AGE formation

Acrylamide

What is it and where does it come from?

Acrylamide is another one of the toxic Mallard reaction end products, forming when asparagine reacts with naturally occurring sugars in high carbohydrate/low protein foods subject to high cooking temperatures. Reactions start at 248 degrees F (120 degrees C).

The higher the cooking temperature and the longer the cooking duration, the more acrylamide.

Most foods that contain acrylamide are cooked commercially and contain the acrylamide when purchased. Think French fries, potato chips, breakfast cereals, crackers, pretzels, coffee, pastries, etc.

If those foods are part of your regular food rotation, you’d better be worried about more than acylamide, most notably grease stains on your couch, grease chunks in your arteries, and knowing the cashier at Winchell’s Donuts on a first name basis.

But we can’t just blame the food manufacturers, since acrylamide is formed during some home food prep. Significant formation requires temperatures greater than 248 degrees F (water simmers at 190 – 200 degrees F and boils into steam at 206 – 212 degrees F).

Diets high in baked or fried starchy foods will contain larger amounts of acrylamide. Diets including more animal products and raw plant foods will be lower.

We can also inhale and otherwise absorb this stuff. You’ll find acrylamide in body lotions, shampoos, tobacco smoke, food packaging, and human breast milk (if mom is ingesting acrylamide).

Why should we worry about it?

Early animal research indicates that acrylamide may be genotoxic, carcinogenic, neurotoxic and create reproductive problems. It’s currently classified as “probably carcinogenic.”

Still, results from human studies indicate that ingestion of acrylamide at current levels fails to produce any measurable neurotoxicity or increases in cancer.

Average intake is estimated to be 0.3 to 2 μg acrylamide/kg bodyweight/day for developed countries. The WHO concluded that an adequate margin of safety at 1-4 μg /kg bodyweight over a lifetime for humans.

What can we do about it?

While we don’t know for sure about acrylamide consumption and disease, it might be best to limit exposure and err on the side of caution.

And notice that the acrylamide-containing foods aren’t all that great for you anyway.

Summary and recommendations

This article is about majoring in the minor. HCAs, PAHs, AGEs, and acrylamide are nutritional details. So make sure to prioritize.

• If your diet is based on processed foods, meats and alcohol – then don’t worry about AGEs in your morning bran flakes. You’ll probably get a disease related to your overall lifestyle first.
• If your diet is already based on whole, unprocessed foods, including lots of plants – then you can start tweaking the finer points of your food preparation methods.

The information in this article adds to previous evidence that a diet based on highly processed foods/meats isn’t the best option for health and can contribute to a range of conditions, from obesity to cancer.

What to do

No matter your style of eating, the highly processed/heated stuff tends to be the most dangerous, including potato chips, French fries, commercial breakfast cereals, grilled meats, fast food meats, deli meats, etc. There are many reasons to avoid this stuff — this is just one more.

When preparing foods, consume unprocessed items that are boiled, steamed, stewed, sprouted, fermented or poached. Avoid high temperature grilling, broiling, roasting, and frying.

Reduce carcinogens by doing the following:

• Use leaner meats
• Use an acidic marinade for meats
• Use lower temperatures and moist heat
• Don’t show off for your grilling buddies with flare-ups
• Don’t overcook
• Hey, why not eat a veggie burger and a regular burger instead of two regular burgers?

It would be impossible to eliminate all carcinogens in food, so don’t think you’re above the system. Further, while high temperatures can create some harmful compounds, it can also destroy harmful compounds. There is a trade off. No need to opt for chicken sashimi just yet.

Extra credit

The AGE content of infant formula is higher than that of human or cow’s milk.

Some food derived AGEs may have beneficial antioxidative and desmutagenic (mutation-fighting) properties.

The main dietary advice that the American Institute for Cancer Research gives is: “Choose mostly plant foods, limit red meat and avoid processed meat.”

HCAs and PAHs seem to be more harmful than acrylamide and AGEs.

Tea and yerba mate may inhibit the formation of AGEs.

Microwaving increased AGE content more rapidly compared to conventional cooking methods in one study.

High levels of methylglyoxal, an intermediate product of the Maillard reaction, are found in commercial soft drinks that contain high fructose corn syrup.

Almonds in most raw almond butters from California are required to go through steam pasteurization. This only raises the temperature of the nut to around 160 degrees F (71 C).

Low carb baked goods with sugar alcohols (maltitol, xylitol) don’t create Maillard reactions. (Unfortunately, the trade-off is often intestinal distress. Maybe just consider cutting back on the pancake intake altogether.)

Further resources

Healthy French Fries? Not

Meat: Good for Us or Disease Waiting to Happen?

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